Uemura Y, Okagawa K, Kawasaki T, Monden M, Kambayashi J, Morimoto F, Sugimoto H
Department of Surgery, Kinki Central Hospital, Itami, Hyogo, Japan.
Surg Today. 1998;28(11):1213-6. doi: 10.1007/s005950050318.
We report herein the case of a 78-year-old man in whom an aortocaval fistula caused by spontaneous rupture of an abdominal aortic aneurysm (AAA) was successfully treated by a unique surgical technique. The aortocaval fistula had been revealed by an aortography after the patient presented with high-output heart failure. During the operation, massive bleeding from the fistula was evident. The fistula measured 2 cm in diameter, and was located between the right posterior wall of the AAA and the inferior vena cava (IVC). Direct suturing of the defect in the IVC failed to close the fistula because the tissue around it would not hold together due to degeneration. However, the bleeding was finally able to be controlled by plugging the fistula with isolated and properly trimmed omentum packed within the excluded aneurysmal sac. Unfortunately, the patient died due to respiratory failure on the 201st postoperative day. A pathological autopsy revealed that the aortocaval fistula had been closed by fibrous tissue and that the IVC was patent. Although such a drastic operative measure to repair an aortocaval fistula has never before been reported, it could be an alternative when direct closure proves unsuccessful.
我们在此报告一例78岁男性患者，其腹主动脉瘤（AAA）自发破裂导致主动脉腔静脉瘘，采用独特的手术技术成功治疗。患者出现高输出量心力衰竭后，主动脉造影显示存在主动脉腔静脉瘘。手术过程中，瘘口大量出血。瘘口直径为2 cm，位于AAA右后壁与下腔静脉（IVC）之间。由于周围组织因退变无法缝合在一起，直接缝合IVC缺损未能闭合瘘口。然而，最终通过将分离并适当修剪的大网膜填入被排除的动脉瘤囊内堵塞瘘口，出血得以控制。不幸的是，患者在术后第201天因呼吸衰竭死亡。病理尸检显示，主动脉腔静脉瘘已被纤维组织封闭，IVC通畅。尽管此前从未报道过如此激进的修复主动脉腔静脉瘘的手术措施，但当直接闭合失败时，它可能是一种替代方法。
