Ghilardi G, Scorza R, Bortolani E, de Monti M, Longhi F, Ruberti U
Istituto di Chirurgia Generale e Cardiovascolare dell'Università degli Studi di Milano, Italy.
Cardiovasc Surg. 1994 Aug;2(4):495-7.
Twenty-two spontaneous aortocaval fistulas between an abdominal aortic aneurysm and the inferior vena cava were surgically treated in 27 years at one surgical unit. The incidence was 5.9% of ruptured abdominal aneurysms; the operative mortality rate of 36.4% compared with an overall mortality rate for ruptured abdominal aortic aneurysms of 34.9%. Among 10 subjects in shock on admission the mortality rate was 50% compared with 25% in non-shocked patients. Of the 22 patients one died at laparotomy from irreversible cardiac arrest; in the other 21 the procedure consisted of endoaneurysmal repair of the fistula which involved replacement of the aneurysm by a Dacron prosthesis after control of venous bleeding was achieved. No occurrence of paradoxical pulmonary embolism was reported. Multiple organ failure caused death in six cases; of these, four died as a result of acute renal failure. Severe preoperative anuric shock was recorded in five instances, with a mortality rate of 80%, compared to 25% for non-shocked subjects. Mortality was not improved by intraoperative autotransfusion; however, the incidence of severe shock was 55.5% in those patients treated by autotransfusion, compared with 38.5% in the standard blood replacement group.
在27年的时间里，某一手术科室对22例腹主动脉瘤与下腔静脉之间的自发性主动脉腔静脉瘘进行了手术治疗。其发生率为破裂性腹主动脉瘤的5.9%；手术死亡率为36.4%，而破裂性腹主动脉瘤的总体死亡率为34.9%。入院时处于休克状态的10例患者中，死亡率为50%，而非休克患者的死亡率为25%。22例患者中，1例在剖腹手术时死于不可逆的心搏骤停；在另外21例患者中，手术包括瘘管的动脉瘤内修复，即在控制静脉出血后，用涤纶人工血管置换动脉瘤。未报告发生矛盾性肺栓塞。6例患者死于多器官功能衰竭；其中4例死于急性肾衰竭。5例患者术前出现严重无尿性休克，死亡率为80%，而非休克患者的死亡率为25%。术中自体输血并未改善死亡率；然而，接受自体输血治疗的患者中严重休克的发生率为55.5%，而标准输血组为38.5%。
