Berhanu Dagim Leykun, Chiman Benjamin Guarken, Bogale Biruk Woisha
Department of Surgery, Hawassa University, College of Medicine and Health Sciences, School of Medicine, Hawassa, Ethiopia.
EJVES Vasc Forum. 2024 Sep 19;62:87-90. doi: 10.1016/j.ejvsvf.2024.09.003. eCollection 2024.
Contained ruptured abdominal aortic aneurysm (CR-AAA) refers to an acute aortic wall disruption leading to expansion of perivascular haematoma that is sealed off by peri-aortic structures. Low and middle income countries have a critical gap in managing abdominal aortic aneurysm (AAA). In Ethiopia, AAA screening is not routine and open surgical repair (OSR) using donated grafts remains the only treatment option. This case shows the first experience at Hawassa University Hospital treating CR-AAA using the superficial femoral vein (SFV) for aortic reconstruction due to lack of prosthetic grafts.
A 40 year old woman presented with three months of abdominal and back pain, vomiting, and a pulsatile abdominal swelling. Imaging showed an 8 cm infrarenal CR-AAA. Due to lack of graft material, a 15 cm SFV was harvested from the left thigh and prepared as a tube graft. OSR via midline laparotomy revealed a 3 cm rupture on the right lateral aortic wall. The reversed SFV graft was anastomosed proximally to the infrarenal aorta, 3 cm below the renal artery, using a 3-0 Prolene suture. Distally, the graft was spatulated for optimal size matching and sewn with a 3-0 Prolene suture at the aortic bifurcation. The procedure lasted 10 hours. Due to the lack of a Cell Saver at the centre, 4 units of whole blood and 4 units of fresh frozen plasma were transfused. Post-operatively, the patient developed bilateral lower extremity swelling, and ultrasound revealed bilateral deep venous thrombosis. Oral anticoagulation was promptly initiated. Follow up imaging confirmed an intact anastomosis with good distal flow. The patient showed clinical improvement in leg swelling at one and three month follow ups. She is scheduled for a six month follow up and will continue regular monitoring.
SFV use in ruptured AAA shows promise in resource limited settings. Sub-Saharan Africa's unique AAA patterns highlight specific healthcare needs. Global collaboration is vital to expand vascular care, funding, and research for better AAA treatment.
局限性破裂性腹主动脉瘤（CR-AAA）是指急性主动脉壁破裂，导致血管周围血肿扩大，该血肿被主动脉周围结构封闭。低收入和中等收入国家在腹主动脉瘤（AAA）管理方面存在重大差距。在埃塞俄比亚，AAA筛查并非常规操作，使用捐赠移植物进行开放手术修复（OSR）仍然是唯一的治疗选择。本病例展示了在哈瓦萨大学医院由于缺乏人工血管移植物，首次使用股浅静脉（SFV）进行主动脉重建治疗CR-AAA的经验。
一名40岁女性，出现腹痛、背痛、呕吐3个月，伴有腹部搏动性肿块。影像学检查显示为8厘米的肾下腹主动脉瘤破裂。由于缺乏移植物材料，从左大腿采集了15厘米的股浅静脉，并制备成管状移植物。经中线剖腹手术进行开放手术修复，发现主动脉右侧壁有3厘米的破裂口。使用3-0普理灵缝线将翻转的股浅静脉移植物近端吻合至肾动脉下方3厘米处的肾下腹主动脉。在远端，将移植物修剪成合适大小以实现最佳尺寸匹配，并在主动脉分叉处用3-0普理灵缝线缝合。手术持续了10小时。由于中心缺乏血液回收机，输注了4单位全血和4单位新鲜冰冻血浆。术后，患者出现双下肢肿胀，超声检查显示双侧深静脉血栓形成。立即开始口服抗凝治疗。随访影像学检查证实吻合口完整，远端血流良好。在1个月和3个月的随访中，患者腿部肿胀的临床症状有所改善。她计划进行6个月的随访，并将继续定期监测。
在资源有限的情况下，使用股浅静脉治疗破裂性腹主动脉瘤显示出前景。撒哈拉以南非洲独特的腹主动脉瘤模式凸显了特定的医疗需求。全球合作对于扩大血管护理、资金和研究以改善腹主动脉瘤治疗至关重要。
