The distinct syndrome of spontaneous abdominal aortocaval fistula

doi:10.1016/0002-9343(68)90117-4

The American Journal of Medicine

Volume 44, Issue 3, March 1968, Pages 464-473

https://doi.org/10.1016/0002-9343(68)90117-4 Get rights and content

Abstract

A case of spontaneous abdominal aortocaval fistula is reported. The patient was successfully operated on but died three months later of unknown causes. Thirty cases of spontaneous aortocaval fistula found in the literature, including our own, were analyzed and compared with eight cases of post-traumatic aortocaval fistula. The striking differences in course are discussed.

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Conservative management of persistent aortocaval fistula after endovascular aortic repair
2013, Journal of Vascular Surgery
Citation Excerpt :
Our case demonstrates that persistent aortocaval communication due to type II endoleak is possible and that a conservative approach may be preferable in the absence of systemic manifestations and in the face of favorable aneurysm sac remodelling. Aortocaval fistulas are, by definition, high-flow fistulas that may result in complications due to increased cardiac output and venous hypertension.5-7 Treatment is therefore advised.
Endovascular repair is a valid alternative for patients with abdominal aortic aneurysms. However, in patients with concomitant aortocaval fistulas, type II endoleaks may result in a persistent communication between the aneurysm sac and the inferior vena cava. In these patients, prompt closure of the persistent fistula has been advocated. We present a patient with an abdominal aortic aneurysm, with aortocaval fistula, who was managed endovascularly. Aneurysm sac shrinkage was observed despite persistent aortocaval communication due to type II endoleak. This case demonstrates that conservative management of type II endoleaks associated with persistent aortocaval fistulas is possible and may result in favorable aneurysm sac remodelling.
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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.
Endovascular repair of a giant arteriovenous fistula: A case study
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¹: From the Department of Surgery, University of Illinois College of Medicine, Chicago, Illinois 60680.

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Case reportThe distinct syndrome of spontaneous abdominal aortocaval fistula

Abstract

Am. J. Cardiol.

Am. J. Cardiol.

Spontaneous arterio-venous fistula between the abdominal aorta and the inferior vena cava

Ann. Surg.

Abdominal aortic aneurysm with rupture into the inferior vena cava

Circulation

Repair of an abdominal vena caval fistula caused by rupture of an atherosclerotic aneurysm

Surgery

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

Ann. Surg.

Rupture of abdominal aortic aneurysm into inferior vena cava. Successful surgical repair

Am. Surgeon

Spontaneous rupture of an abdominal aortic aneurysm into the inferior vena cava

J.A.M.A.

Ruptured abdominal aneurysm occurring in Marfan's syndrome

New England J. Med.

Spontaneous arteriovenous fistula between the abdominal aorta and the vena cava

Arch. Surg.

Aneurisma de aorta fistulizado espontáneamente en vena cava inferior

Tórax

Aneurysm of the abdominal aorta with rupture into the inferior vena cava. Report of two successfully treated cases

New England J. Med.

Abdominal arteriovenous fistulas

Surg. Gynec. & Obst.

Perforation of arteriosclerotic aneurysms into inferior vena cava

Arch. Surg.

Rupture of abdominal aortic aneurysm in vena cava

Arch. Int. Med.

Case report
The distinct syndrome of spontaneous abdominal aortocaval fistula