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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

A Journal on Vascular and Endovascular Surgery


Official Journal of the Italian Society of Vascular and Endovascular Surgery
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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


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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.

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