Aorto-caval fistula resulting from rupture of an abdominal aortic aneurysm—Report and review of Japanese reported cases

doi:10.1016/S0950-821X(05)80353-6

European Journal of Vascular Surgery

Volume 5, Issue 5, October 1991, Pages 601-604

https://doi.org/10.1016/S0950-821X(05)80353-6 Get rights and content

Rupture of an abdominal aortic aneurysm into the venous system such as the inferior vena cava, the iliac vein or the renal vein occurs rarely. Our own experience illustrating this uncommon lesion is presented, and 25 reported cases in Japan including our own were clinically analysed.

The physician's awareness of this clinically rare entity is the most important factor for the early diagnosis and treatment of this disease.

References (59)

GoreI et al.
Arteriosclerotic aneurysms of the abdominal aorta: Review
Prog Cardiovasc Dis
(1973)
NennhausHP et al.
The distinct syndrome of spontaneous abdominal aortocaval fistula
Am J Med
(1968)
JohnsonJM et al.
Arteriovenous fistula secondary to rupture of atherosclerotic abdominal aortic aneurysm
Am J Surg
(1978)
EpsteinDH et al.
Atypical spontaneous aorto-caval fistula: CT appearance
Computerized Radiol
(1986)
WuAVO
The preoperative recognition of aorto-caval syndrome
Eur J Vasc Surg
(1989)
ShibaudaY et al.
Two operated cases of arterio-venous fistula
J Jap Coll Angiol
(1966)
IshikawaM et al.
A case of an abdominal aortic aneurysm which formed an aorto-caval fistula
Geka
(1973)
MorikawaT et al.
An operated case of 87-year-old female with an aorto-caval fistula
Geka
(1974)
IshikuraY et al.
Surgical repair of ruptured abdominal aneurysm into inferior vena cava
Rinsho-Geka
(1974)
KazuiT et al.
Surgical repair of aortocaval fistula resulted from rupture of abdominal aortic aneurysm
Shujutsu
(1981)

SezaiY et al.

A case of simultaneous surgical treatment of unstable angina with perforative abdominal aortic aneurysm

Kyobu-Geka

(1982)

TakahashiY et al.

A successful operative case of abdominal aneurysm with aortocaval fistula, presenting with refractory congestive failure and angina

Shinzo

(1984)

MiyoshiA et al.

One operative of dissecting aneurysm with arterio-venous fistula

J Jpn Soc Clin Surg

(1984)

NozuC et al.

A case of abdominal aortic aneurysm which ruptured into the left iliac vein and caused symptoms resembling deep vein thrombosis

J Jpn Surg Soc

(1985)

IkezawaT et al.

Abdominal aortic aneurysm ruptured into the inferior vena cava or into the iliac vein

Jpn J Cardiovasc Surg

(1985)

SakauchiM et al.

Aortocaval fistula secondary to rupture of abdominal aortic aneurysm: Report of two cases

J Jpn Surg Soc

(1985)

NakanoK et al.

Abdominal arteriovenous fistula due to rupture of aorto-iliac aneurysm with multivarious clinical manifestations. Report of a case with successful repair

J Jpn Surg Soc

(1986)

AmemiyaA et al.

Hematuria—An important sign of aorto-caval fistula secondary to ruptured abdominal aortic aneurysm

Jikeikai Med J

(1985)

AnzaiT et al.

Surgery of ruptured abdominal aortic aneurysm

J Jpn Soc Clin Surg

(1986)

KanekoK et al.

Surgical treatment of aorto-caval fistula resulted from ruptured abdominal aortic aneurysm

Jpn J Cardiovasc Surg

(1988)

YamamotoK et al.

Aorto-caval fistula complicated with DeBakey IIIb type dissecting aortic aneurysm: Report of a case

J Jpn Surg Soc

(1988)

IshibeR et al.

Aorto-caval fistula due to ruptured abdominal aortic aneurysm: An emergency operation following echoic diagnosis

J Jpn Surg Soc

(1988)

OhgiS et al.

Abdominal aortic aneurysm with primary arteriovenous fistula—Case reports

Vasc Surg

(1988)

SymeJ

Case of spontaneous varicose aneurysm

Edinb Med Surg J

(1831)

DebakeyME et al.

Arteriovenous fistula involving the abdominal aorta: Report of four cases with successful repair

Ann Surg

(1958)

BakerWH et al.

Aortocaval fistula as a complication of abdominal aortic aneurysms

Surgery

(1972)

RubertiU et al.

Nineteen year experience on the treatment of aneurysms of the abdominal aorta: a survey of 832 consecutive cases

J Cardiovasc Surg

(1985)

FalkGL et al.

Intravenous rupture of abdominal aneurysms: Diagnostic and pathological considerations

Aust N Z J Surg

(1986)

LehmanEP

Spontaneous arteriovenous fistula between the abdominal aorta and the inferior vena cava

Ann Surg

(1938)

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Aortocaval fistulas (ACFs) are rare complications of abdominal aortic aneurysms (AAA), with an incidence of 0.22% to 6.04%, associated with a significant increase in mortality rate because of both their direct clinical repercussion and the technical difficulty involved in their treatment. Owing to technical limitations related to the open treatment of AAA with ACFs, as well as their associated morbidity and mortality rates, endovascular treatment is an important option to consider.
However, under such clinical situations, the morphology of the aneurysm and the possibility of endoleak may present as limitations to an endovascular approach, as the endoleak is seen as the most frequent complication in the treatments of AAAs.
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Unfortunately, he succumbed to multiorgan dysfunction. Aortocaval fistula is a rare complication of abdominal aortic aneurysm, usually secondary to erosion caused by an aneurysm.1 Its clinical features include back or abdominal pain, pulsatile abdominal lump, auscultable bruit, and at times, right heart failure in chronic cases.2
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The aortovenous fistulas are rare, most of them are aortocaval fistula. The non-caval communication of the fistula is sparse. Herein we report a 47-year-old female diagnosed as traumatic aorto-superior mesenteric vein (Ao-SMV) fistula. The abdominal pain, fullness, and frank bruit on abdominal auscultation suggested the diagnosis of an intra-abdominal arteriovenous fistula. The diagnosis of Ao-SMV was further confirmed by the computed tomography (CT) and aortography. The fistula was successfully treated with transcatheter coil embolization. This is the first case of Ao-SMV fistula. It provides an alternative option of treatment other than conventional surgery.
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The surgical repair of 16 aorto-caval (A-C) fistulas (15 male and one female patient; average age of 61.3 years) is reviewed. Fourteen fistulas were caused by aneurysm’s erosion, one by iatrogenic injury, while one followed abdominal blunt trauma. The interval from presumed occurrence to diagnosis ranged from 6 h to 2 years. The presence of an abdominal bruit (87.5%) was the most reliable physical finding. Congestive heart failure was prominent in three (18.7%) cases, while severe lower extremity edema in five (31.2%). Two patients (12.5%) had hematuria, two (12.5%) renal insufficiency, while four (25%) scrotal edema. The diagnosis was not recognized before the surgery in five (31.2%) cases. In all 16 cases after transaortic suture of the fistula, aortic reconstructions were performed. Four operative deaths (25%) occurred, in patients who were not correctly diagnosed before surgery. In one case the cause of death was massive bleeding, and in three MOFS. All other patients were followed from 1 to 17 years (mean 4 years and 2 months). All grafts are patent, and there is no lower extremity venous insufficiency or pelvic venous hypertension. Surgical repair of A-C fistulas is mandatory to prevent serious complications.
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Case reportAorto-caval fistula resulting from rupture of an abdominal aortic aneurysm—Report and review of Japanese reported cases

Prog Cardiovasc Dis

Am J Med

Am J Surg

Computerized Radiol

Eur J Vasc Surg

Two operated cases of arterio-venous fistula

J Jap Coll Angiol

A case of an abdominal aortic aneurysm which formed an aorto-caval fistula

Geka

An operated case of 87-year-old female with an aorto-caval fistula

Geka

Surgical repair of ruptured abdominal aneurysm into inferior vena cava

Rinsho-Geka

Surgical repair of aortocaval fistula resulted from rupture of abdominal aortic aneurysm

Shujutsu

A case of simultaneous surgical treatment of unstable angina with perforative abdominal aortic aneurysm

Kyobu-Geka

A successful operative case of abdominal aneurysm with aortocaval fistula, presenting with refractory congestive failure and angina

Shinzo

One operative of dissecting aneurysm with arterio-venous fistula

J Jpn Soc Clin Surg

A case of abdominal aortic aneurysm which ruptured into the left iliac vein and caused symptoms resembling deep vein thrombosis

J Jpn Surg Soc

Abdominal aortic aneurysm ruptured into the inferior vena cava or into the iliac vein

Jpn J Cardiovasc Surg

Aortocaval fistula secondary to rupture of abdominal aortic aneurysm: Report of two cases

J Jpn Surg Soc

Abdominal arteriovenous fistula due to rupture of aorto-iliac aneurysm with multivarious clinical manifestations. Report of a case with successful repair

J Jpn Surg Soc

Hematuria—An important sign of aorto-caval fistula secondary to ruptured abdominal aortic aneurysm

Jikeikai Med J

Surgery of ruptured abdominal aortic aneurysm

J Jpn Soc Clin Surg

Surgical treatment of aorto-caval fistula resulted from ruptured abdominal aortic aneurysm

Jpn J Cardiovasc Surg

Aorto-caval fistula complicated with DeBakey IIIb type dissecting aortic aneurysm: Report of a case

J Jpn Surg Soc

Aorto-caval fistula due to ruptured abdominal aortic aneurysm: An emergency operation following echoic diagnosis

J Jpn Surg Soc

Abdominal aortic aneurysm with primary arteriovenous fistula—Case reports

Vasc Surg

Case of spontaneous varicose aneurysm

Edinb Med Surg J

Arteriovenous fistula involving the abdominal aorta: Report of four cases with successful repair

Ann Surg

Aortocaval fistula as a complication of abdominal aortic aneurysms

Surgery

Nineteen year experience on the treatment of aneurysms of the abdominal aorta: a survey of 832 consecutive cases

J Cardiovasc Surg

Intravenous rupture of abdominal aneurysms: Diagnostic and pathological considerations

Aust N Z J Surg

Spontaneous arteriovenous fistula between the abdominal aorta and the inferior vena cava

Ann Surg

Case report
Aorto-caval fistula resulting from rupture of an abdominal aortic aneurysm—Report and review of Japanese reported cases