Aneurysm rupture into a large vein — case reports

Abstract

An aneurysm is a widening of artery by at least 50% compared with the unchanged part located above and it is the result of pathological changes occurring in the wall of the vessel and mechanical factors. Aortic aneurysm rupture is directly life-threatening condition. More than 95% of abdominal aortic aneurysms rupture into retroperitoneal space. About 5% of those rupture into peritoneal cavity, inferior vena cava with aortocaval fistula formation, into duodenum with primary aortoduodenal fistula formation, into iliac vein and left renal vein. Those rare types of aneurysms ruptures comprise also chronic contained ruptures. In 2006 in The Department of General and Vascular Surgery of M. Pirogow Hospital in Lodz 4 patients were hospitalized due to an aneurysm rupture into a large vein. Two cases involved rupture of iliac artery aneurysm into iliac vein, two 3/4 abdominal aortic aneurysm rupture into the inferior vena cava. All of them were qualified for surgical treatment in emergency: in two cases after computed tomography (angio-CT) and after duplex ultrasonography (USG-D) were made, in one case after angio-CT was made only, in one case after USG-D was made only. The operations were performed using transperitoneal approach and included reconstructions by a vascular grafts after fistulas repair. In two cases postoperative course was complicated by clinical and biochemical signs of renal insufficiency, which gradually disappeared during treatment. In one case postoperative course was complicated by sudden symptoms of bleeding into gastrointestinal tract and the patient died. In one case there was no complication in postoperative course. Aneurysm rupture into the lumen of the abdominal organs is a rare complication and include only 4% of cases. In those more than 70% of fistulas are discovered intraoperativly. This is because of the clinical manifestation of an aneurysm rupture into a large vein can proceed with different symptoms. Angio-CT is the diagnostic method of chose for fistulas between aneurysms and large veins. Still the primary method of treatment of aneurysm rupture into a large vein is the classic surgical treatment, involving the closure of the fistula and reconstruction of the aorta with vascular graft. An alternative to open surgery is the intravascular grafting. Perioperative mortality in patients with aneurysm rupture into the lumen of a large vein is about 16–70%.