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Query: UMLS:C0162871 (abdominal aortic aneurysm)
 8,664 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The diagnostic features and operative results of six patients with spontaneous aorto-caval fistula associated with abdominal aortic aneurysm were analyzed. Abdominal pain, pulsatile abdominal mass and haematuria were constant preoperative findings in all patients. Radiological signs of congestive heart failure of various degrees were present in five, abdominal bruit in four and preoperative renal failure in three patients. As preoperative diagnostic examinations i.v. pyelography was done in two patients and ultrasound scanning and angiography of the abdominal aorta in a further two patients. In one ultrasound scanning a dilated inferior vena cava and hepatic veins were seen as an indirect sign of ACF, while in both angiograms the ACF was seen. In these two cases the diagnosis of ACF was made preoperatively, while in four other cases the diagnosis was made during the operation. Three patients survived the operation and were still alive after eight months, four years and six years respectively. Postoperative complications developed in two patients: postoperative ileus in one and deep venous thrombosis and pneumonia in another. Because of its rarity aorto-caval fistula is difficult to diagnose. The presence of haematuria in a patient suffering from abdominal aortic aneurysm should strongly suggest the diagnosis of an aorto-caval fistula.
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PMID:Diagnosis and treatment of spontaneous aorto-caval fistula. 355 68

Over the period January 1965-July 1992 26 spontaneous fistulas between an abdominal aortic aneurysm (AAA) and the major abdominal veins were observed and surgically treated. Twenty-two were aorto-caval, one iliaco-iliac and 3 aorto-iliac; since clinical features, pathophysiology, principles of surgical treatment and postoperative care are similar, both the conditions are considered as a single disease (aorto-caval fistula: ACF). The incidence among 373 ruptured AAA operated in emergency conditions in the same period was 6.97%, with an operative mortality rate of 34.61% compared to an overall mortality for ruptured AAA of 34.85%. All subjects were males with a mean age of 67.3 years. Twelve subjects showed shock at admission (46.1%): the mortality rate in this subgroup was 50% compared to 21.4% among the non-shocked patients. Pain was always present, oedema of one or both of the lower limbs in 9 cases (34.6%) and abdominal bruit or murmur and thrill in 16 (61.5%). One patient died at laparotomy for irreversible cardiac arrest; the 25 completed procedures consisted of endoaneurysmal repair of the fistula under venous bleeding control by digital compression and prosthetic replacement of the abdominal aorta (7 straight and 18 bifurcated grafts). Intraoperative mean blood losses exceeded 4,000 ml, but autotransfusion, available only in 12 procedures, allowed significant sparing of heterologous blood units. The mortality rate was not clearly improved by autotransfusion, but among these 12 patients shock was present in 7 instances (58.3%), compared to 5 out of 14 subjects (35.7%) operated on before autotransfusion devices were available.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Rupture of abdominal aortic aneurysms into the major abdominal veins. 848 3