Radiologic Diagnosis of Primary Aortic Fistulas

The diagnosis of rare forms of ruptured abdominal aortic aneurysms, such as aortocaval and aortoenteric fistula, is a difficult challenge due to rarity of case, severity of patient condition and non-specificity of clinical manifestations. Aim. To define the decision for multifield clinics usable criteria of aortic fistulas radiologic diagnosis Materials and methods. An experience of diagnosis and treatment of 8 (2.4%) patients with primary abdominal aortic fistulas (3 cases of aortoenteric and 5 cases of aortocaval) in group of 340 patients with complicated abdominal aortic aneurysms was analyzed. All of the patients were underwent ultrasound and CT-study. Clinical verification by means of surgical repair were done. Results. CTA was revealed as a “gold standard” in diagnosis of aortocaval and aortoenteric fistulas both. The principal sign was an extravasation of contrast agent into bowel or vein. However, specific signs were detected in ultrasound and CT study. There were a dense connection between aneurysm and intestine wall, gas bubbles in intraluminal thrombi and aortic wall for aortoenteric fistula; oval form of cava vein, pulsatile flow in its lumen or shunt pattern. Conclusion. The specific signs of aortic are feasible for identification in particular in multifield clinics.

разрыв аневризмы брюшной аорты, ультразвуковое исследование, дуплексное сканирование, компьютерная томографическая ангиография, неотложная лучевая диагностика, аортокишечная фистула, аортокавальная фистула, raptured abdominal aortic aneurysm, ultrasound, duplex scanning, computed tomographic angiography, emergency radiology diagnosis, aortocaval fistula, aortoenteric fistula

1. Turton E.P., Scott D.J., Delbridge M. et al. Ruptured abdominal aortic aneurysm: a novel method of outcome prediction using neural network technology. Eur. J. Vasc. Endovasc. Surg. 2000; 19: 184-189.

2. Казанчян П.О., Попов В.А., Сотников П.Г. Разрывы аневризм брюшной аорты. Особенности клинического течения и классификация. Ангиология и сосудистая хирургия. 2003; 9 (1): 84-88.

3. Visser P., Akkersdijk G.J.M., Blankensteijn J.D. In-hospital operative mortality of ruptured abdominal aortic aneurysm: A population-based analysis of 5593 patients in the Netherlands over a 10-year period. Eur. J. Vasc. Endovasc. Surg. 2005; 30: 359-364.

4. Johansson G., Swedenborg J. Ruptured abdominal aortic aneurysms: a study of incidence and mortality. Br. J. Surg. 1986; 73: 101-103.

5. Спиридонов А.А., Тутов Е.Г., Прядко С.И. и др. Современные принципы диагностики и хирургического лечения аневризм брюшной аорты. Анналы хирургии. 1999; 6: 100-105.

6. Marckovic M., Davidovic L., Marsimovic Z. et al. Effect of intraoperativ parameters on survival in patients with ruptured abdominal aortic aneurysm. Srp. Arh. Celok. Lek. 2004; 132 (2): 5-9.

7. Naito K., Sakai M., Natsuaki M. Itoh T. A new approach for aortocaval fistula from ruptured abdominal aortic aneurysms. Balloon occlusion technique under echogram guidance. Thorac. Cardiovasc. Surg. 1994; 42: 55-57.

8. Dossa C.D., Pipinos I.I., Shepard A.D., Ernst C.B. Primary aortoenteric fistula. Ann. Vasc. Surg. 1994; 8: 113-120.

9. Alexander J.J., Imbemdo A.L. Aorto-vena cava fistula. Surgery. 1989; 105: 1-12.

10. Calligaro K.D., Savarese R.P., De Laurentis D.A. Unusual aspects of aortovenous fistulas associated with ruptured abdominal aortic aneurysms. J. Vasc. Surg.1990; 12: 586-590.

11. Song Y., Liu Q., Shen H. et al. Diagnosis and management of primary aortoenteric fistulas-experience learned from eighteen patients. Surgery.2008; 143: 43-50.

12. Затевахин И.И., Матюшкин А.В. Осложненные аневризмы абдоминальной аорты. М.: Литтерра, 2010. 208 с.

13. Андрейчук К.А., Сорока В.В., Постнов А.А. и др. Первичные аорто-кишечные фистулы (обзор литературы и описание клинических наблюдений). Ангиология и сосудистая хирургия. 2012; 18 (3): 153-158.

14. Brewster D.C., Cambria R.P., Moncure A.C. et al. Aortocaval and iliac arteriovenous fistulas: recognition and treatment. J. Vasc. Surg.1991; 13: 253-265.

15. Андрейчук К.А., Сорока В.В., Андрейчук Н.Н. Редкие формы осложненных аневризм брюшной аорты. Кардиология и сердечно-сосудистая хирургия. 2015; 4: 30-36.

16. MacDougall L., Painter J., Featherstone T. et al. Aortoenteric fistulas: a cause of gastrointestinal bleeding not to be missed. BJMP. 2010; 3 (2): 217-219.

17. Yeong K.Y. Angiographic demonstration of primary aortoenteric fistula: a case report. Ann. Acad. Med. Singapore. 1995; 24: 467-469.

18. Leonhardt H., Mellander S., Snygg J., Lönn L. Endovascular management of acute bleeding arterioenteric fistulas. Cardiovasc. Intervent. Radiol. 2008; 31: 542-549.

19. Vu Q.D.M., Menias C.O., Bhalla S. et al. Aortoenteric Fistulas: CT Features and Potential Mimics. RadioGraphics. 2009; 29: 197-209.

20. Reiner M.A., Brau S.A., Schanzer H. Primary aortoduodenal fistula. Case presentation and review of literature. Am. J. Gastroenterol. 1978; 70 (3): 292-297.