腎摘術後動静脈瘻による2次性心不全—1治験例および文献的考察

Secondary cardiac disease due to postnephrectomy arterio-venous fistula. Report of a case and review of literature

　外科手術後に発生する後天性動静脈瘻の報告は稀である。このうち腎摘術後動静脈瘻（本症）は1934年のHollingsworthによる初例報告^1）以来，欧米文献で43件，本邦では樋口らの1例^2）を渉猟し得るに過ぎない。

　われわれは最近，興味ある臨床経過を示した本症の1例を経験し，幸い外科治療し得たので文献的考察を加え報告する。

An arteriovenous fistula between the residual stumps of the renal artery and vein is reported in a 52 year old female 20 years following right ne-phrectomy for tuberculosis. The patient presented with the manifestations of high output cardiac fail-ure. The diagnosis was confirmed by retrogradeabdominal aortogram. Hemodynamic studies reveal-ed the profound effects of the fistula on cardiac output, stroke volume, peripheral vascular resistance etc. Ligation of the renal arterial stump resulted in disappearance of the bruit and improvement in symptoms. Three weeks later hemodynamic findings were normal, but hypertension persisted and post-operative ECG demonstrated profoud subendocardi-al ischemia.

In 46 previous reports fistulas were operated five months to thirty-five years postnephrectomy. Slow evolution of cardiac decompensation was noted in 70 per cent ; a bruit was heard in most. The precise etiology of this entity remains obscure although there are several theories as to causation. Surgical corrective approaches vary ; results indicate cure or improvement in most.