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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 2003 March;10(1):77-88
language: English, Italian
Aorto-caval fistula: a complication of ruptured abdominal aortic aneurysms
La Barbera G., La Marca G., Mavaro G., Martino A.
Unità Operativa di Chirurgia Vascolare Ospedale Civico G. Di Cristina e M. Ascoli, Palermo
Spontaneous rupture of abdominal aortic aneurysms into the inferior vena cava is exceptional and is the principal aetiology of aorto-caval fistula. In this retrospective study the authors focus on aspects concerning clinical presentation, physiopathological aspects and diagnostic and therapeutic management. Over the past 20 years, a total of 158 patients underwent emergency surgery for ruptured abdominal aortic aneurysm. Seven patients (4.4%) had an aorto-caval fistula, of whom 4 had been treated by suture of the fistula from inside the aneurysmatic sac, 2 underwent inferior vena cava ligature and in one patient the fistula was closed using a PTFE patch sutured from inside the aneurysm. The mean diameter of the aneurysms was 8.2 cm. One patient died in the operating theatre from cardiac arrest and 3 patients died on the 1st postoperative day from cardiac failure, thereby giving a 57% postoperative mortality rate. One patient treated with PTFE patch, and 2 patients treated using fistula suture from inside the aneurysm, were discharged respectively 29, 30 and 40 days after the operation.
Aorto-caval fistula is a rare complication of ruptured abdominal aortic aneurysms. The possible presence of this complication must be kept in mind in large diameter aneurysms. The success of treatment depends on rapid diagnosis and prompt closure of the arteriovenous communication.