A Case of a Common Iliac Aneurysm Perforating the Inferior Vena Cava and Complicated with Cardiac Arrest due to a Progression of Hyperkalemia

DOI 1 Citations 17 References
  • Uegaki Shinji
    Department of Emergency and Critical Care Medicine, Sapporo City General Hospital
  • Hayakawa Mineji
    Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine
  • Yamazaki Kei
    Department of Emergency and Critical Care Medicine, Sapporo City General Hospital
  • Sato Tomoyuki
    Department of Emergency and Critical Care Medicine, Sapporo City General Hospital
  • Matsui Toshihisa
    Department of Emergency and Critical Care Medicine, Sapporo City General Hospital
  • Makise Hiroshi
    Department of Emergency and Critical Care Medicine, Sapporo City General Hospital
  • Gando Satoshi
    Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine

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Other Title
  • 急激に進行した高カリウム血症から心停止に至った総腸骨動脈瘤下大静脈瘻の１例

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A 69-year-old male was transferred to our department in a state of shock and circulatory collapse. Contrast enhanced computed tomography showed a bilateral common iliac aneurysm and the early enhancement of a dilated inferior vena cava. In addition, iliocaval fistula was diagnosed by aortography. Although sudden cardiac arrest occurred before performing an emergency operation, a recovery of the spontaneous circulation was observed after about 15 minutes of cardiopulmonary resuscitation. A surgical closure of the fistula with graft replacement was successfully performed, followed by a reduction of the cardiac output (10 to 4.6 l/min) and the central venous pressure (28 to 12 mmHg). Unfortunately, however, anoxic encephalopathy occurred due to cardiac arrest. Arteriocaval fistula is one of the rare complications of an aortic aneurysm rupture. Varying degrees of clinical symptoms are observed depending on the size of the fistula and the duration of the disease, which thus makes an accurate diagnosis of such an iliocaval fistula very difficult. Recent studies recommend the use of multidetector row angio-CT for the preoperative comfirmatory diagnosis of a fistula. Due to the extremely high mortality rate associated with a direct surgical repair of the fistula, endvascular treatment has therefore recently been adopted. It is therefore important to evaluate the hemodynamic changes carefully in patients presenting with a large iliocaval fistula during the perioperative state.

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