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  

Analysis of Causes and Preventive Measures of Misdiagnosed Giant Common Iliac Arteriovenous Fistula Manifested as Biventricular Heart Failure

作　　者：张腾飞[1] 唐小斌[1] 杨耀国[1] 陈忠[1] ZHANG Tengfei;TANG Xiaobin;YANG Yaoguo;CHEN Zhong(Vascular Surgery Center,Beijing Anzhen Hospital Affiliated to Capital Medical University,Beijing 100013,China)

机构地区：[1]首都医科大学附属北京安贞医院血管外科中心,北京100013

出　　处：《临床误诊误治》2025年第9期7-13,共7页Clinical Misdiagnosis & Mistherapy

基　　金：国家自然科学基金(82271610)。

摘　　要：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。Objective To investigate the causes and preventive measures of misdiagnosed common iliac arteriovenous fistula(AVF).Methods The clinical data of a patient with giant common iliac AVF misdiagnosed as biventricular heart failure admitted to our hospital in 2024 were retrospectively analyzed.The clinical characteristics of patients,diagnosis and treatment process,and causes of misdiagnosis were summarized.Results Twenty-six years ago,the patient underwent exploratory laparotomy for the first time in another hospital due to trauma,but the diagnosis of left external iliac AVF was not confirmed.Ten years ago,the patient was diagnosed with dilated cardiomyopathy and heart failure due to shortness of breath after activity.Diuretics and other medications were administered for treatment.Two months ago,the patient sought medical attention again due to worsening wheezing.Ultrasound examination revealed a pseudoaneurysm of the abdominal aorta.Computed tomography angiography(CTA) and digital subtraction angiography confirmed the diagnosis of right and left common iliac AVF,abdominal aortic aneurysm,and aneurysmal dilatation of inferior vena cava.The misdiagnosis lasted 10 years.After diagnosis,abdominal aorta and covered stent graft exclusion for bilateral iliac arteries were performed,the fistula was closed and heart failure was controlled.At 1 month after operation,the echocardiography showed that the global heart was smaller than before,and the heart rhythm returned to normal.There was no obvious symptoms of heart failure during the telephone follow-up at 2 months after operation.Conclusion Common iliac AVF has no typical clinical manifestations.Clinicians should raise awareness of the disease,especially in patients with a history of trauma.A thorough history and physical examination,along with the accurate use of diagnostic methods,are essential to prevent severe complications resulting from misdiagnosis and missed diagnosis.

关 键 词：髂总动静脉瘘 心力衰竭 腹主动脉假性动脉瘤 误诊 漏诊 心肌病 扩张型 髂动脉腔内修复 血管造影术 数字减影 

分 类 号：R654.3[医药卫生—外科学]