2007 Volume 18 Issue 7 Pages 291-296
Spontaneous rupture of an abdominal aortic aneurysm into the vena cava is rare and, in most cases, the symptoms are presented over an interval of several days or even months. Herein, we describe successful treatment of a patient with cardiopulmonary arrest due to an iliac arteriovenous fistula. A 65-year old man with no past history complained of acute chest and back pain, and was transferred to our hospital under a diagnosis of acute myocardial infarction. Soon after arrival, the patient fell into shock and cardio-pulmonary arrest. Following cardiopulmonary resuscitation, recovery of spontaneous circulation was immediately obtained and an abdominal aortic aneurysm was detected by echocardiogram findings. Further, an iliac arteriovenous fistula was detected by enhanced CT imaging and an emergency operation was commenced. Venous bleeding was controlled by insertion of a urinary balloon catheter and the fistula was closed from within the aneurysm with interrupted sutures. The patients was discharged 31 days after surgery without disability. In the present patient, the fistula was relatively wide and enlarged much quicker than that reported in other cases, as blood flow from the arterial circulation was suddenly diverted by it into the venous circulation, leading to so-called distributive shock.
