Aortic Fistulas: Pathophysiologic Features, Imaging Findings, and                Diagnostic Pitfalls

Gulati, Achal; Kapoor, Harit; Donuru, Achala; Gala, Kunal; Parekh, Maansi

doi:10.1148/rg.2021210004

Cited by 9 publications

(10 citation statements)

References 74 publications

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“…Active extravasation of intravenous contrast into the enteric lumen is a rare but specific sign for AEF and is only likely to have been present in this case due to the acute severity of the bleed 2. Traditionally, more common signs include air in the aneurysm sac or periaortic area, and focal bowel wall thickening 3. Other indirect signs include aortic pseudoaneurysm, surrounding soft tissue abnormalities and loss of planes between aorta and bowel 2 3…”

Section: Discussionmentioning

confidence: 85%

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Massive gastrointestinal bleed due to a primary aortoenteric fistula

Stanley,

Nguyen,

Sivasuthan

et al. 2024

BMJ Case Rep

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A man in his 60s attended emergency for acute-onset abdominal pain and haematemesis. Requiring resuscitation, a CT abdomen/pelvis revealed a primary aortoenteric fistula actively bleeding into the duodenum. His background included a previous severe Q-fever infection and a heavy smoking history. Despite attempts at resuscitation and an emergent surgical attempt at haemostasis, the patient did not survive the massive gastrointestinal haemorrhage.Even in less severe cases, management of aortoenteric fistulas is tricky. Blood cultures and angiographic imaging are important investigations in guiding surgical approach. The pathology tends to have a significant rate of mortality even at tertiary-level vascular surgical centres.

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Section: Discussionmentioning

confidence: 85%

“…Traditionally, more common signs include air in the aneurysm sac or periaortic area, and focal bowel wall thickening 3. Other indirect signs include aortic pseudoaneurysm, surrounding soft tissue abnormalities and loss of planes between aorta and bowel 2 3…”

Section: Discussionmentioning

confidence: 99%

Massive gastrointestinal bleed due to a primary aortoenteric fistula

Stanley,

Nguyen,

Sivasuthan

et al. 2024

BMJ Case Rep

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“…An aortocaval fistula is an abnormal vascular communication between the aorta [generally an abdominal aortic aneurysm (AAA)] and the inferior vena cava (IVC) [ 1 ]. It is a rare entity, most commonly seen in the setting of a ruptured abdominal aorta aneurysms, with an estimated incidence ranging from <1% to as high as 10% [ 2–5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Marfan, Ehler–Danlos syndrome), vasculitis (e.g. polyarteritis nodosa), hematogenous infections, prior spinal surgery, malignancy and radiation exposure [ 2 , 6 ]. Penetrating trauma or spinal injury with thoracolumbar translation may also lead to aortocaval fistula formation.…”

Section: Introductionmentioning

confidence: 99%

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Incidental aortocaval fistula in the setting of an unruptured abdominal aortic aneurysm

Sohail

Cohen

et al. 2023

Journal of Surgical Case Reports

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An aortocaval fistula, a rare abnormal vascular communication between the aorta and inferior vena cava, is most commonly associated with abdominal aortic aneurysms (AAAs). Other factors leading to aortocaval fistula formation include atherosclerosis, collagen vascular diseases, vasculitis, hematogenous infections, prior spinal surgery, malignancy and radiation exposure. In rare instances, aortocaval fistulas may be discovered incidentally on abdominal imaging. We report an unusual case of an incidental aortocaval fistula in a 93-year-old male patient with an unruptured AAA, presenting with shortness of breath, malaise and lethargy. The patient had no other obvious risk factors for aortocaval fistula formation. Multidetector computed tomography angiography helped identify the fistula, and the patient was eventually transferred to hospice for comfort measures. This case highlights the importance of detailed imaging and preoperative planning in managing aortocaval fistulas and associated AAAs.

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