摘要
目的总结探讨1例腹主动脉瘤合并髂动静脉瘘患者的诊断过程及治疗经验。方法回顾性分析南充市中心医院于2019年12月收治并在术前进行MDT讨论的1例累及髂动脉的腹主动脉瘤合并左髂动静脉瘘的病例资料,对患者的诊疗经过及MDT讨论结果进行总结。结果该患者的临床表现为难治性心功能衰竭,收治于南充市中心医院心内科,后行CT血管造影(CTA)后诊断为累及髂动脉的腹主动脉瘤合并左髂动静脉瘘,经MDT讨论后行腹主动脉腔内覆膜支架隔绝术(EVAR),术后造影显示腹主动脉瘤瘤腔及左髂动静脉瘘瘘口完全封闭,术后患者心功能衰竭症状迅速缓解。整个手术顺利,手术用时约120 min,术中出血量约100 mL。术后第7天患者出院。术后3个月复查CTA及彩超,见支架内血流通畅,未见内漏,左髂动脉假性动脉瘤消失。继续随访。结论对于难治性心功能衰竭患者,如果合并下肢肿胀时,要考虑到大血管动静脉瘘可能,应全面收集病史和查体,及时进行必要的检查,避免造成漏诊或误诊。同时,与传统外科手术对比,EVAR是腹主动脉瘤合并髂动静脉瘘的一种可靠、微创及安全的治疗手段。
Objective To summarize the diagnosis and treatment experience of one case of abdominal aortic aneurysm with iliac arteriovenous fistula.Methods A case of abdominal aortic aneurysm with left iliac arteriovenous fistula admitted to Nanchong Central Hospital in December 2019 was retrospectively analyzed.The diagnosis and treatment of the patient and the MDT discussion results were summarized.Results The clinical manifestations of this patient was refractory heart failure,and he received heart medicine treatment in Nanchong Center Hospital.The patient diagnosed as abdominal aortic aneurysm with left iliac arteriovenous fistula after computed tomography angiography(CTA),abdominal aorta lumen coated stents isolation(EVAR)during operation was performed after the MDT discussion.Postoperative imaging revealed a tumor cavity abdominal aortic aneurysm and left iliac arteriovenous fistula completely closed,then the heart failure symptoms of the patient was quickly relieved.The whole operation went smoothly,with a duration of about 120 min and intraoperative blood loss of about 100 mL.The patient was discharged from hospital on the 7th day after the operation.CTA and color doppler ultrasound were rechecked in 3 months after the operation,and the stent was found to have unobtrusional blood flow and no internal leakage,and the pseudoaneurysm of the left iliac artery disappeared.Conclusions For patients with refractory heart failure,if accompanied by lower limb swelling,the possibility of arteriovenous fistula of the great vessels should be taken into account,and the medical history and physical examination should be collected comprehensively,and necessary examinations should be carried out timely to avoid missed diagnosis or misdiagnosis.Meanwhile,compared with traditional surgery,EVAR is a more reliable,minimally invasive,and safe treatment for abdominal aortic aneurysm with iliac arteriovenous fistula.
作者
袁宇航
杜果城
YUAN Yuhang;DU Guocheng(The Second Affiliated Medical College of North Sichuan Medical College,Nanchong,Sichuan 637000,P.R.China;Department of Thyroid,Breast,and Vascular Surgery,Nanchong Central Hospital,Nanchong,Sichuan 637000,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2020年第10期1290-1294,共5页
Chinese Journal of Bases and Clinics In General Surgery
关键词
腹主动脉瘤
动静脉瘘
血管腔内治疗
诊断
MDT
abdominal aortic aneurysm
arteriovenous fistula
intravascular treatment
diagnosis
MDT
