Aortocaval Fistula Formation due to Ruptured Abdominal Aortic Aneurysms

Abstract

This study reports on the frequency and management of aortocaval fistulas (ACFs) in our department between 1998 and 2009. Overall frequency of ACFs among ruptured abdominal aortic aneurysms was 5.5%. Patients presented with low back pain (92.8%), abdominal tenderness (78.6%), hemorrhagic shock (28.6%), congestive heart failure (21.4%), dyspnea (42.8%), and palpitations (57.1%). The most reliable clinical sign was the presence of palpable pulsating abdominal mass (92.8%). Other clinical findings included increased central venous pressure (21.4%), lower extremity edema (71.4%), hematuria (21.4%), and scrotal edema (14.3%). Diagnosis was established preoperatively in 85.7% and intraoperatively in 14.3% of cases. Surgery was successful in promptly improving clinical signs and symptoms. Mortality rate was 7.1%. After a mean follow-up of 18.5 months, all surviving patients remained free from complications. In conclusion, ACFs represent a life-threatening emergency for vascular surgeons but can be successfully managed.

A rare presentation of a rare complication of ruptured AAA... how cardiology comes into play

“…It was first described by Syme in 1831 and it took many years until the first successful operation of a fistulating abdominal aortic aneurysm was performed by Cooley in 1954 [1,2]. Most publications are case reports or reviews, reporting an incidence of 0.22-6% of spontaneous aortocaval fistula in presence of abdominal aortic aneurysm rupture [5][6][7][8]. Patients usually are male and 60 to 70 years old [4][5][7][8][9][10].…”

“…Rapid diagnostic assessment, computed tomography or ultrasound [4,6], and surgical intervention are crucial [3]. Reported mortality rates are in the range of 16-66% [4][5]9] and significantly higher than with rupture into the retroperitoneal cavity [3][4]7].…”

“…Decision making in these patients can be difficult as symptoms of circulatory and respiratory failure mask the classic symptoms of abdominal aortic aneurysm rupture with features of haemorrhagic shock with lower back pain, abdominal pain, palpitations. Clinical examination may show a pulsating abdominal mass with bruits, an elevated central venous pressure, oedemas, hematuria or oliguria and scrotal oedemas [5][6][7][9][10]. Deep palpation and auscultation of the abdomen in all quadrants, inguinal region and the kidneys should be considered in every patient.…”

“…Besides atherosclerosis, which is the aetiology in most cases, trauma, interventions, infectious diseases like syphilis connective tissue disorders (Marfan-and Ehlers-Danlos-syndrome), Takayasu arteriitis or neoplasms may cause fistulating aneurysms [3][4][5][6]10].…”

Images in medicine: Spontaneous aortocaval fistula complicating abdominal aortic aneurysm

“…Alternatively, in sporadic cases, ACF may develop secondary to trauma, spine surgery, or interventional procedures, syphilis, or mycotic aneurysm from infectious endocarditis, Takayasu's arteritis, Marfan syndrome, or Ehlers-Danlos syndrome. [123]…”