SUCCESSFUL SURGICAL TREATMENT OF A PATIENT WITH ANEURISM OF THE ABDOMINAL AORTA COMPLICATED BY THE FORMATION OF A SPONTANEOUS AORTO-CAVAL FISTULA

Abstract

Aim: This case demonstrates the successful result of urgent open surgery in a patient with polysymptomatic manifestations of aortocaval fistula. Clinical observation: Patient N., 61 years old, was taken to the hospital by an ambulance team 10 days after the onset of the disease with complaints of shortness of breath, swelling of both lower extremities, pain, localized in the lumbar region. The deterioration of the condition notes in the last 2 days with the occurrence of shortness of breath at rest. Based on clinical and instrumental data, a diagnosis was established: Aortic atherosclerosis. Aneurysm of the infrarenal aorta. Complication: Spontaneous aortocaval fistula. Compression of the inferior vena cava. Secondary lymphovenous insufficiency. Operation highlights: Aneurysm has a saccular-fusiform shape, spreading to the proximal part of the common iliac arteries, measuring 150 mm in length and from 70 to 90 mm across. After systemic heparinization, the aorta and iliac arteries are pinched longitudinally, an aneurysmal sac is opened, 150 ml of red blood was evacuated from the cavity of the aneurysm to Cell-Saver. After this, an intense flow of dark blood was noted. A massive thrombotic cup was removed in the lower third. A proximal anastomosis of the InterGard Silver 18-9-9cm bifurcation prosthesis was formed with an aortic 4/0 proline thread of the end-to-end type, the prosthesis branches were placed on the hips. An anterolateral wall of the common femoral arteries was excised and anastomoses formed with 6/0 proline thread of end-to-side type. Smooth postoperative course.Conclusion: The development of the aortocaval fistula with abdominal aortic aneurysms should be considered an extremely rare complication. In turn, based on our own experience of 587 operations of similar operations performed in our clinic over the past 18 years, we first encountered the above complication of abdominal aortic aneurysms (frequency was 0.1%)