Sakauchi M, Abe K, Yoshida K, Yoshida H, Itoh I, Hamada Y, Niitsu K
Nihon Geka Gakkai Zasshi. 1985 Oct;86(10):1456-61.
Two cases of aortocaval fistula secondary to rupture of abdominal aortic aneurysm were presented. First case was 70 year old man who was admitted with pulsating abdominal mass. Prior to admission, he had been suffering from congestive heart failure. On physical examination, a pulsating mass, remarkable thrill and continuous bruit were recognized on his abdomen. Aortography showed abdominal aortic aneurysm and aortocaval fistula. The fistula (5mm X 3mm) was repaired within the aneurysm controlling the bleeding from the fistula by the direct digital compression. Aortic reconstruction was done with woven dacron bifurcation graft. Postoperative course was uneventful. Second case was 68 year old man who was admitted with the sudden onset of severe back pain. On admission, his physical status was already deteriorated. Diagnosis was made easily by the physical examination. Immediately after aortography, cardiac arrest occurred suddenly. After resuscitation, he was operated in the same manner of the first case. Large fistula (2 cm X 1cm) was noted. This patient died of renal failure and cerebral damage on 30th post operative day. Problems of pre- and post-operative patient management and surgical therapy for aortocaval fistula secondary to rupture of abdominal aortic aneurysm were discussed.
本文报告了两例腹主动脉瘤破裂继发主动脉腔静脉瘘的病例。第一例是一名70岁男性，因腹部搏动性肿块入院。入院前，他患有充血性心力衰竭。体格检查时，在其腹部可触及搏动性肿块、明显的震颤和连续性杂音。主动脉造影显示腹主动脉瘤和主动脉腔静脉瘘。通过直接手指压迫控制瘘口出血，在动脉瘤内修复了瘘口（5mm×3mm）。采用编织涤纶分叉移植物进行主动脉重建。术后过程顺利。第二例是一名68岁男性，因突然发作的严重背痛入院。入院时，他的身体状况已经恶化。通过体格检查很容易做出诊断。主动脉造影后立即突然发生心脏骤停。复苏后，他以与第一例相同的方式接受了手术。发现有较大的瘘口（2cm×1cm）。该患者在术后第30天死于肾衰竭和脑损伤。讨论了腹主动脉瘤破裂继发主动脉腔静脉瘘患者术前和术后管理及手术治疗的问题。
