Griffin L H, Fishback M E, Galloway R F, Shearer G L
Surgery. 1977 Apr;81(4):480-3.
Fistulas between the abdominal aorta and renal vein are exceedingly rare. Diagnostic delays are not unusual. Correction can be extremely difficult because of anatomical distortion and size of the arterialized veins. A young woman with such a fistula following a gunshot wound is presented. Four years following injury, the fistula was repaired successfully during intentional arrest of the circulation for 7 minutes. This was accomplished with deep hypothermia and cardiopulmonary bypass. No serious problems occurred during the operation. The patient tolerated the procedure well and has been relieved of her symptoms completely. Most patients with traumatic or spontaneous arteriovenous fistulas can be managed safely and effectively by conventional operative techniques. In selected situations, the risk of total circulatory arrest and deep hypothermia may be less than the risk of uncontrollable bleeding inherent in conventional techniques. Suggested indications for use of total circulatory arrest in vascular surgery are (1) inability to achieve vascular control by more conventional means, (2) massive distention of regional veins as occurrs in well established fistulas of the trunk, (3) one or more prior corrective attempts with use of conventional techniques, and (4) anticipated anatomical distortion and/or multiple abnormal vascular communications. This technique is a valuable approach to the correction of otherwise inoperable cardiovascular lesions.
腹主动脉与肾静脉之间的瘘极为罕见。诊断延迟并不少见。由于解剖结构扭曲和动脉化静脉的大小，修复可能极其困难。本文介绍了一名因枪伤导致这种瘘的年轻女性。受伤四年后，在循环故意停搏7分钟期间成功修复了瘘。这是通过深度低温和体外循环完成的。手术期间未出现严重问题。患者对手术耐受良好，症状已完全缓解。大多数创伤性或自发性动静脉瘘患者可通过传统手术技术安全有效地治疗。在某些情况下，全循环停搏和深度低温的风险可能低于传统技术固有的无法控制出血的风险。血管手术中使用全循环停搏的建议指征为：（1）无法通过更传统的方法实现血管控制；（2）区域静脉大量扩张，如在已形成的躯干瘘中出现的情况；（3）使用传统技术进行过一次或多次先前的矫正尝试；（4）预期的解剖结构扭曲和/或多个异常血管交通。该技术是纠正其他无法手术的心血管病变的一种有价值的方法。
