临床误诊误治2025，Vol.38Issue(9)：7-13,7.DOI:10.3969/j.issn.1002-3429.2025.09.002
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 Com-mon Iliac Arteriovenous Fistula Manifested as Biventricular Heart Failure
摘要
Abstract
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 fail-ure admitted to our hospital in 2024 were retrospectively analyzed.The clinical characteristics of patients,diagnosis and treat-ment 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,abdomi-nal 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 af-ter 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Key words
Common iliac arteriovenous fistula/Heart failure/Abdominal aortic pseudoaneurysm/Misdiagnosis/Missed diagnosis/Cardiomyopathy,dilated/Endovascular repair of iliac artery/Angiography,digital subtraction分类
临床医学引用本文复制引用
张腾飞,唐小斌,杨耀国,陈忠..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(9):7-13,7.基金项目
国家自然科学基金(82271610) （82271610）
