Aortocaval Fistula - A case report -

대동맥-대정맥루 -치험 1예-

  • Cho Kwang-Hyun (Department of Thoracic & Cardiovascular Surgery, Busan Paik Hospital, College of Medicine, Inje University) ;
  • Kwon Young-Min (Department of Thoracic & Cardiovascular Surgery, Busan Paik Hospital, College of Medicine, Inje University) ;
  • Han Il-Yong (Department of Thoracic & Cardiovascular Surgery, Busan Paik Hospital, College of Medicine, Inje University) ;
  • Jun Hee-Jae (Department of Thoracic & Cardiovascular Surgery, Busan Paik Hospital, College of Medicine, Inje University) ;
  • Lee Yang-Haeng (Department of Thoracic & Cardiovascular Surgery, Busan Paik Hospital, College of Medicine, Inje University) ;
  • Hwang Youn-Ho (Department of Thoracic & Cardiovascular Surgery, Busan Paik Hospital, College of Medicine, Inje University) ;
  • Yoon Young-Chul (Department of Thoracic & Cardiovascular Surgery, Busan Paik Hospital, College of Medicine, Inje University)
  • 조광현 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 권영민 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 한일용 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 전희재 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 이양행 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 황윤호 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 윤영철 (인제대학교 의과대학 부산백병원 흉부외과학교실)
  • Published : 2005.10.01

Abstract

Aortocaval fistula is a rare complication of abdominal aortic aneurysm, involving less than $1\%$ of all abdominal aortic aneurysms. A 64-years old man with a long history of hypertension and abdominal aortic aneurysm had chest pain, dyspnea, epigastric discomfort and palpable abdominal pulsating mass. Physical examination revealed hypo­tension with a systolic blood pressure of 70 mmHg, a large pulsatile mass and a systolic abdominal bruit. Laboratory data revealed a hemoglobin values of 11.0 g/dL, blood urea nitrogen (BUN) value of 5 mg/dL, and creatine value of $2.5 mg\%$. Abdominal Angio CT showed a 10cm infrarenal abdominal aortic aneurysm with dilatation of the IVC and aortocaval fistula from the aortic aneurysm, which was confirmed at emergency surgery. When the aneurysm was opened and the thrombus was removed, a 1 cm communication was identified between the aorta and IVC. This was controlled with Foley catheters ballooning, and the fistula was closed by continuous suture placed outside the aneurysm. A bifurcated aorto-iliac graft was used to restore arterial continuity. The patient was discharged home after uncomplicated postoperative course.

대동맥-대정맥 누공은 복부 대동맥류의 $1\%$ 이하에서 발생하는 희귀한 합병증 중 하나이다. 오랜 기간 동안 고혈압과 복부 대동맥류 병력을 가진 64세 남자 환자가 흉통, 호흡곤란, 상복부 불쾌감 그리고 박동성 복부 종괴를 주소로 내원하였다. 이학적 검사상 수축기 혈압이 70mmHg로 저혈압을 보였고, 복부에서는 박동성 종괴가 촉지되었고, 지속성 기계 잡음이 청진되었다. 검사실 소견으로는 혈색소(11.0 g/dL), BUN (5 mg/dL), creatine $(2.6\;mg\%)$이었고, 복부 전산화 혈관 촬영 결과, 10cm 크기의 신장하복부대동맥류와 복부 대동맥류와 대정맥을 연결하는 대동맥-대정맥 누공이 형성되어 확장된 대정맥 소견을 보여 응급 수술을 계획하였다. 대동맥류를 절개하고 혈전 제거 후, 1cm크기의 대동맥-대정맥 누공이 발견되었다. 대동맥-대정맥 누공은 도뇨관 풍선 확장술을 이용하여 지혈하였고, 대동맥류 밖에서 누공은 단순 지속 문합으로 봉합하였다. 대동맥-양측 장골동맥 이식편을 이용하여 대동맥류에 대한 수술을 마무리하였다. 환자는 수술 후 특별한 문제없이 퇴원하였다.

Keywords

References

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