Abstract
We describe an 87-year-old man with an arteriovenous fistula that arose due to the spontaneous rupture of abdominal aortic and right common iliac aneurysms into the right common iliac vein. Such arteriovenous communication is rarely associated with this atherosclerotic aneurysm, but it represents a life-threatening complication. The primary symptom in this patient was bilateral leg edema. He was admitted with abdominal distension and dyspnea. Echocardiography did not detect left heart failure, but the right atrium and inferior vena cava were enlarged. A pulsating mass with vascular bruit and thrill was located in the right lateral abdomen. Computed axial tomography confirmed that the mass was an aneurysm of 60 mm in maximal diameter in the right common iliac artery, and that the lower abdominal aorta and left common iliac artery were dilated. Surgery was perfomed to treat an arteriovenous fistula that had perforated the right common iliac aneurysm. After opening the aneurysm using a median laparotomy approach, we found an orifice 10 mm in diameter in the right common iliac arterial wall. The fistula was closed from inside the aneurysm using 2 interrupted sutures with 4-0 monofilament polypropylene. A Y-shaped prosthetic graft replaced from the abdominal aorta to the bilateral external iliac artery, and the right internal and left common iliac arteries were ligated. The surgical diagnosis was an arteriovenous fistula between the right common iliac artery and vein, which caused high output heart failure. These procedures improved both the bilateral leg edema and the heart failure.
