| A Case of Isolated Right Common
Iliac Aneurysm with Arteriovenous Fistula |
(Department of Surgery, Mito Red Cross Hospital,
Mito, Japan)
| Norio Uchida |
Yasuko Miyaki |
|
|
We report a case of arteriovenous
fistula (AVF) secondary to spontaneous rupture of the right common
iliac aneurysm into the right common iliac vein. In February
2003, an 81-year-old woman was admitted with dyspnea. Diuretics
and digitalis were given under a provisional diagnosis of primary
heart failure. Afterwards the heart failure turned out to be
high output failure due to AVF. In June the patient complained
of swelling of her right leg and was referred to our department.
Ultrasonography to determine deep vein thrombosis of the right
femoral vein revealed a dilatation of the left femoral vein,
but there was no thrombosis. A pulse Doppler detected an arterial
blood flow signal during early systolic pulse in the right femoral
vein, confirming the suspicion of an AVF in abdominal cavity
near this location. A pulsatile mass associated with bruit and
thrill was palpable in the lower abdomen. Digital subtraction
angiography showed a 50mm aneurysm of the right common iliac
artery. Rapid visualization of the inferior vena cava and retrograde
opacification of the right iliac vein indicated the presence
of an AVF between the common iliac artery and vein. Operation
was done by laparotomy on June 24, 2003. An occlusive balloon
catheter was inserted from the right femoral vein and the balloon
was dilated to patch the fistula before opening the aneurysm.
After clamping the proximal and distal arteries the aneurysm
was opened. By this maneuver there was no bleeding from the fistula.
The AVF was closed from inside the aneurysm by 3 interrupted
4-0 monofilament sutures. The aneurysm was replaced with a prosthetic
graft (Hemashield 8mm). The post-operative course was uneventful.
The lower limb edema subsided and heart failure improved.
Jpn. J. Cardiovasc. Surg. 34: 120-123 (2005) |
|
