首都医科大学附属北京安贞医院血管外科中心;
目的 探讨髂总动静脉瘘的误漏诊原因及防范措施。方法 回顾性分析2024年收治的1例误诊的表现为全心力衰竭的巨大髂总动静脉瘘患者的临床资料,总结患者临床特点、诊疗过程、误诊原因。结果 患者26年前因创伤,首次于外院行开腹探查术,未明确诊断左侧髂外动静脉瘘,10年前因活动后喘憋,诊断为“扩张型心肌病,心力衰竭”,予利尿等药物治疗,2个月前因喘憋加重再次就诊,行超声检查提示腹主动脉假性动脉瘤,完善计算机断层扫描血管造影及数字减影血管造影检查后确诊为右侧髂总动脉-左侧髂总静脉瘘、腹主动脉瘤、下腔静脉瘤样扩张。误诊时间10年。确诊后行腹主动脉-双髂动脉覆膜支架隔绝术,患者瘘口封闭,心力衰竭得以控制。术后1个月复查超声心动图显示全心较前缩小,心率降至正常,术后2个月电话随访无明显心力衰竭症状。结论 髂总动静脉瘘临床表现不典型,临床医生应提高对该病的认识,尤其是对于有外伤史者应仔细问询病史及查体,准确使用检查方法,以防止误漏诊所致的严重并发症。
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下载次数 | 被引频次 | 阅读次数 |
[1] 黄高昇,郭思恩.Viabahn覆膜支架治疗下肢创伤性股动静脉瘘1例[J].介入放射学杂志,2022,31(10):1031-1033.
[2] 李朋,马钊,张峰,等.医源性股动静脉瘘合并髂总静脉狭窄1例[J].实用放射学杂志,2017,33(9):1492.
[3] PAPADOULAS S,KONSTANTINOU D,KOUREA H P,et al.Vascular injury complicating lumbar disc surgery.A systematic review[J].Eur J Vasc Endovasc Surg,2002,24(3):189-195.
[4] DAHL J S,ANDERSEN C,DUVNJAK S,et al.Two cases of high-output heart failure as initial presentation of iliac arteriovenous fistula[J].BMJ Case Rep,2018,2018:bcr2018225659.
[5] SALA ALMONACIL V A,ZARAGOZá GARCíA J M,GóMEZ PALONéS F J,et al.Endovascular repair of an iliac arteriovenous fistula secondary to perforation from a common iliac aneurysm in a patient with Ehler-Danlos syndrome[J].Ann Vasc Surg,2012,26(6):861.
[6] DEWANE M P,FARES W H,OCHOA CHAAR C I.Endovascular treatment of a large iliac vein aneurysm and high-flow arteriovenous fistula[J].Ann Vasc Surg,2018,53:266.
[7] 师龙,侯佳豪,高翔.腹主及双髂动脉瘤合并髂动静脉瘘致心力衰竭1例[J].中华普通外科杂志,2024,39(1):66-67.
[8] 葛静,张强,张永恒,等.左侧髂总动静脉瘘误诊1例并文献复习[J].四川医学,2018,39(7):835-837.
[9] BREWSTER D C,CAMBRIA R P,MONCURE A C,et al.Aortocaval and iliac arteriovenous fistulas:recognition and treatment[J].J Vasc Surg,1991,13(2):253-264.
[10] WANG E A,LEE M H,WANG M C,et al.Iatrogenic left iliac-caval fistula:imaging and endovascular treatment[J].AJR Am J Roentgenol,2004,183(4):1032-1034.
[11] NAOULI H,JIBER H,BOUARHROUM A.Iliac arteriovenous fistula following lumbar disc surgery.A case report[J].J Med Vasc,2022,47(4):199-202.
[12] SALAGEAN M,GINGHINA C,GEANA R C,et al.Iatrogenic iliac arteriovenous fistula management after lumbar discectomy surgeries:a case report and review of the literature[J].Heart Surg Forum,2020,23(6):E863-E866.
[13] KOSUM P,CHATTRANUKULCHAI P,THEERASUWIPAKORN N,et al.An unusual cause of high-output heart failure from the iliac arteriovenous fistula after lumbar discectomy:a case report[J].Radiol Case Rep,2023,18(6):2140-2144.
[14] YAN G W,LI H W,YANG G Q,et al.Iatrogenic arteriovenous fistula of the iliac artery after lumbar discectomy surgery:a systematic review of the last 18 years[J].Quant Imaging Med Surg,2019,9(6):1163-1175.
[15] AUER A I,SAUER D C,LEVIN M.Iliac arterio-venous fistula from an aneurysm following seat belt trauma[J].Angiology,1974,25(1):21-23.
[16] KUEHNL A,ZIMMERMANN A,PONGRATZ J,et al.Young girl presenting with heart failure 5 years after laparoscopic appendectomy.Case report of an ilio-iliac AV fistula[J].Eur J Vasc Endovasc Surg,2010,40(1):107-109.
[17] 夏士博,宋超,张雷,等.左髂静脉血栓形成合并左下肢动静脉瘘误诊误治1例[J].中国血管外科杂志(电子版),2019,11(2):148-149.
[18] SCHLAGER O,WOLF F,MUELLER M,et al.Closure of post-thrombotic iliac arteriovenous fistulas by iliac vein recanalization[J].J Endovasc Ther,2024,31(1):157-163.
[19] 高文艺,尹德馨,方宗钰,等.髂静脉压迫综合征合并特发性髂动静脉瘘1例报告[J].中国实用外科杂志,2021,41(10):1197-1198.
[20] SOTO J A,MUNERA F,CARDOSO N,et al.Diagnostic performance of helical CT angiography in trauma to large arteries of the extremities[J].J Comput Assist Tomogr,1999,23(2):188-196.
[21] SEXTON J A,RICOTTA J J.Endovascular approaches to arteriovenous fistula[J].Adv Surg,2011,45:83-100.
[22] 何才华,巍杰利,王黎洲,等.腔内治疗创伤性右侧髂动静脉瘘伴血管瘤样扩张1例[J].中国介入影像与治疗学,2024,21(9):576.
[23] JI L,GU G,LIU Z,et al.Clinical features and endovascular management of iliac arteriovenous fistulas:a 10-year single center experience[J].Front Surg,2022,9:873665.
[24] SPANOS K,MATSAGKAS M.Endovascular treatment of a giant iliac vein aneurysm after a traumatic arteriovenous fistula[J].Eur J Vasc Endovasc Surg,2022,64(5):451.
[25] KOTELIS D,KLEMM K,VON TENGG-KOBLIGK H,et al.Intermittent claudication secondary to a traumatic arteriovenous fistula[J].Vasa,2007,36(4):285-287.
[26] THOMPSON P C,ULLERY B W,FLEISCHMANN D,et al.Novel approach to a giant external iliac vein aneurysm secondary to posttraumatic femoral arteriovenous fistula[J].Vasc Endovascular Surg,2015,49(5/6):148-151.
[27] ZOU J,YANG H,MA H,et al.Pulmonary embolism caused by a thrombosed external iliac venous aneurysm[J].Ann Vasc Surg,2011,25(7):982.
[28] 张艳华.超声对外周血管动静脉瘘诊断的临床价值分析[J].影像研究与医学应用,2019,3(12):195-196.
[29] 龙晚生,梁宇闯,张红环,等.腹盆腔动静脉瘘的彩超、CT、DSA诊断比较[J].遵义医学院学报,2013,36(6):552-556.
[30] CHEN J K,JOHNSON P T,FISHMAN E K.Diagnosis of clinically unsuspected posttraumatic arteriovenous fistulas of the pelvis using CT angiography[J].AJR Am J Roentgenol,2007,188(3):W269-273.
[31] VAN ZITTEREN M,FAN B,LOHLE P N,et al.A shift toward endovascular repair for vascular complications in lumbar disc surgery during the last decade[J].Ann Vasc Surg,2013,27(6):810-819.
[32] 王晓东,SALVATORE JA SCLAFANI.108例创伤性动静脉瘘的介入诊疗分析[J].介入放射学杂志,2010,19(7):521-526.
[33] LIM E T,KHANAFER A.An open approach to a ruptured common iliac artery aneurysm with resultant ilio-iliac arteriovenous fistula[J].Vascular,2024,32(1):25-27.
[34] ZAJKO A B,LITTLE A F,STEED D L,et al.Endovascular stent-graft repair of common iliac artery-to-inferior vena cava fistula[J].J Vasc Interv Radiol,1995,6(5):803-806.
[35] YOO Y S.Endovascular repair of an ilio-iliac arteriovenous fistula following rupture of common iliac artery aneurysm with an aortic extension cuff in common iliac vein:a case report[J].Medicine (Baltimore),2022,101(2):e28548.
[36] 胡双龙,胡亚立,卢辉俊.巨大左髂内动脉瘤合并动静脉瘘行腔内修复1例[J].中国微创外科杂志,2024,24(1):75-78.
[37] SEBASTIAN A,ALMADANI M,PU Q,et al.Endovascular repair of right-sided iliac vein aneurysm and iliac arteriovenous fistula[J].J Vasc Surg Cases Innov Tech,2023,9(3):101181.
[38] PIRANEO J M,MORDECAI R,ESPINOSA J,et al.Spontaneous iliac arteriovenous fistula leading to high-output heart failure and cardiac arrest[J].Cureus,2024,16(1):e51876.
[39] 周世方,丁宁,杨志伟,等.无痛性主动脉夹层八例临床特点和误诊分析[J].临床误诊误治,2023,36(1):5-8.
[40] YAMAMOTO Y,KENZAKA T,KUROKI S,et al.Spontaneous arteriovenous fistula of left internal iliac artery aneurysm[J].Eur Heart J Cardiovasc Imaging,2015,16(7):817.
[41] 吕艺芝,杨坚,陈郁明,等.我国三级医院多学科协作诊疗模式开展现状调查分析[J].中国医院,2021,25(2):21-23.
基本信息:
DOI:
中图分类号:R541.6
引用信息:
[1]张腾飞,唐小斌,杨耀国等.表现为全心力衰竭的巨大髂总动静脉瘘误漏诊原因分析及防范措施[J].临床误诊误治,2025,38(09):7-13.
基金信息:
国家自然科学基金(82271610)