A Case of Aorto-caval Fistula Caused by Rupture of an Abdominal Aortic Aneurysm

Abstract

We report the successful surgical treatment of an aortocaval fistula caused by rupture of an abdominal aortic aneurysm (AAA). A 71-year-old man was admitted upon presenting with abdominal pain. Abdominal computed tomography revealed rupture of an AAA with communication between the aneurysm and the inferior vena cava (IVC). The maximum dimension of the AAA was 57 mm. The ruptured AAA was complicated by an aortocaval fistula, and therefore indicated emergency surgery. We introduced an occlusion balloon catheter from the right femoral vein into the IVC. The abdominal aorta was clamped, and we opened the aneurysm to reveal a large fistula of 46×16 mm in maximum dimensions communicating with the IVC. We inflated the occlusion balloon catheter in the IVC at the fistula, and the bleeding from the IVC was thereby completely controlled. We closed the aortocaval fistula with a polytetrafluoroethylene patch and replaced the abdominal aorta with a knitted Dacron bifurcated graft. The patient recovered without any complications. The surgical repair of a large aortocaval fistula between an AAA and the IVC is often complicated by massive bleeding from the fistula, which can result in hemorrhagic shock. Venous occlusion achieved by inflating an occlusion balloon catheter in the IVC can control the bleeding from the fistula, which was useful to prevent massive bleeding in the present case.