Kiskinis D A, Saratzis N, Megalopoulos A, Hatzibaloglou A, Gitas C, Dalainas V
Department of Vascular Surgery, Ahepa General Hospital, Aristotelian University School of Medicine, Thesaloniki, Macedonia, Greece.
Ann Vasc Surg. 1994 Sep;8(5):496-9. doi: 10.1007/BF02133071.
We report three cases in which ruptured aneurysm and aortocaval fistula went undetected until surgery was performed. Preoperative features suggestive of an arteriovenous fistula were not apparent in any of these patients; they all presented with cardiovascular collapse and all underwent emergency laparotomy after a ruptured abdominal aortic aneurysm was diagnosed. The fistula was discovered unexpectedly only after the aneurysmal sac was opened and the thrombus evacuated. In the first two patients the fistula was successfully sutured from within the aneurysmal sac. The first patient died 1 week postoperatively from rupture of a previously known associated thoracic aortic aneurysm and the second patient died during the operation from excessive blood loss. The third patient had a large fistula requiring an interposition synthetic graft to restore the continuity of the vena cava; the graft has remained patent 15 months postoperatively. Aortocaval fistula is an uncommon complication of aneurysmal aortic disease and may coexist with a rupture of the aneurysm into the retroperitoneum. In emergency cases such as ours it is usually discovered unexpectedly during the operation. The established method of treatment is to oversew the fistula from within the aneurysm; however, when the fistula is large reconstruction of the infrarenal inferior vena cava with an interposition synthetic graft is a good alternative to caval ligation.
我们报告了三例病例，其中动脉瘤破裂和主动脉腔静脉瘘直到手术时才被发现。这些患者术前均未出现提示动静脉瘘的特征；他们均表现为心血管衰竭，在诊断为腹主动脉瘤破裂后均接受了急诊剖腹手术。仅在打开动脉瘤囊并清除血栓后才意外发现瘘管。在前两名患者中，瘘管成功地从动脉瘤囊内缝合。第一名患者术后1周因先前已知的相关胸主动脉瘤破裂死亡，第二名患者在手术期间因失血过多死亡。第三名患者有一个大的瘘管，需要植入人工血管来恢复腔静脉的连续性；术后15个月人工血管仍保持通畅。主动脉腔静脉瘘是动脉瘤性主动脉疾病的一种罕见并发症，可能与动脉瘤破裂进入腹膜后腔并存。在我们这样的急诊病例中，通常在手术期间意外发现。既定的治疗方法是从动脉瘤内缝合瘘管；然而，当瘘管较大时，用植入人工血管重建肾下下腔静脉是替代腔静脉结扎的一种好方法。
