AORTOCAVAL FISTULA ASSOCIATED WITH RUPTURED ABDOMINAL AORTIC ANEURYSM

Abstract

Aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm. It may sometimes influence the hemodynamics severely. A case of ACF caused by rupture of abdominal aortic aneurysm into the inferior vena cava is presented.
A 68-year-old male was admitted to the hospital because of sudden onset of general fatigue indicating acute cardiac failure. A pulsatile abdominal mass was found in association with a thrill and bruits on the right side of the mass. A diagnosis of ACF was made based on the clear findings of enhanced CT. The fistula was closed from within the opened aneurysm sac and aortic continuity was restored with a Dacron bifurcation graft. Widened pulse pressure, high CVP, high cardiac output and tachycardia were improved immediately after the reconstructive surgery.
Although the diagnosis of ACF usually requires angiography for confirmation, CT scanning is useful for preoperative assessment of aneurysm and can demonstrate the presence of ACF.