| A Successfully Treated Case of
Abdominal Aortic and Iliac Aneurysms Associated with Iliac Arteriovenous
Fistula |
| Makoto Funami |
Takashi Narisawa |
Shigeaki Sekiguchi |
| Hiroyuki Tanaka |
Makoto Yamada |
Tadanori Kawada |
| Toshihiro Takaba |
|
|
(First Department of Surgery, School of Medicine,
Showa University, Tokyo, Japan)
|
A 72-year-old man suffering from
congestive heart failure, swelling of the lower limbs and hematuria
was transferred from another hospital with a diagnosis of large
aneurysms of the abdominal aorta and the left common iliac artery.
Iliac arteriovenous fistula (AVF) was definitively diagnosed
preoperatively by contrast-enhanced CT and angiogaphy. At operation,
an infrarenal abdominal aortic aneurysm of 8cm and left iliac
arterial aneurysm of 12cm were identified. After proximal and
distal aortic clamping, the aneurysm was entered and an AVF orifice
of 1cm communicating with the left common iliac vein was disclosed
at the right posterior wall of the left common iliac artery.
Venous blood reflux was controlled by inserting an occlusive
balloon catheter to the fistula and intraoperative shed blood
was aspirated and returned by an autotransfusion system. The
AVF was closed from inside the iliac aneurysm by three interrupted
3-0 monofilament mattress sutures with pledgets. The aneurysms
were resected and replaced with a bifurcated Dacron prosthetic
graft. The patient had an uncomplicated postoperative recovery;
the lower limb edema subsided and heart failure improved rapidly.
Preoperative identification of the location of the AVF is mandatory
to make surgery safe. Moreover, easy availability or routine
use of the devices for controlling undue blood loss such as an
autotransfusion system and an occlusive balloon catheter are
other important supplementary means to obtain good results of
surgical treatment.
Jpn. J. Cardiovasc. Surg. 31: 304-307 (2002) |
|
