J Korean Surg Soc.  2009 Jan;76(1):66-71. 10.4174/jkss.2009.76.1.66.

Primary Aortocaval Fistua Associated with Abdominal Aortic Aneurysm

• Kim HK
• Choi HH
• Huh S

• KMID: 2040608
• DOI: http://doi.org/10.4174/jkss.2009.76.1.66

Abstract

Primary aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA), occurring in only 4% of ruptured cases and less than 1% of all AAAs. The hemodynamic changes resulting from the major shunt caused by the ACF include a sudden increase in inferior vena caval pressure and volume with renal venous hypertension and a decrease in total peripheral resistance. So, if untreated, it leads to irreversible high output heart failure. Preoperative diagnosis is crucial, as adequate preparation should be made for massive bleeding expected at operation. Successful treatment depends on management of perioperative hemodynamics, control of bleeding from fistula and prevention of thromboembolism. We report two cases of successfully treated spontaneous ACF with a review of the literature.

Keyword

Abdominal aortic aneurysm; Aortocaval fistula; Operative therapy

MeSH Terms

Aortic Aneurysm, Abdominal
Fistula
Heart Failure
Hemodynamics
Hemorrhage
Hypertension
Thromboembolism
Vascular Resistance

Figure

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  Fig. 1 Patient #1. (A) Early synchronous and equivalent enhancement of the IVC and aorta and localized intimal dissection of aorta (arrow). (B) 4 cm sized infrarenal abdominal aortic aneurysm. (C) Control of both iliac arteries and veins. (D) Dacron patch closure of fistula (arrow) and bifurcated graft.

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  Fig. 2 Patient #2. CT findings of aortocaval fistula associated with abdominal aortic aneurysm (A) early synchronous and equivalent enhancement of the IVC and aorta (B) 9×8 cm sized infrarenal abdominal aortic aneurysm (C) direct visualization of aortocaval fistula (arrow) (D) both common iliac artery aneurysm.

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  Fig. 3 Patient #2. Operative findings (A) Foley catheter into the aortocaval fistula (B) fistula closure within the aneurysmal sac (C) closed fistula (arrow) and bifurcated Dacron graft.

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