Traumatic fistula between the aorta and the left renal vein: Case report and review of the literature

Abstract

This report of an aorto-left renal vein fistula (ALRVF) of traumatic origin is the sixth such case on record. The fistula was successfully repaired, with preservation of the kidney, by autotransfusion. Review of the English language literature revealed the differences between spontaneous and traumatic ALRVF. Spontaneous fistulas were caused by rupture of an abdominal aortic aneurysm into a retroaortic left renal vein. Hematuria was almost constant (93% of cases). The operative mortality rate was 14%. By contrast, traumatic ALRVFs were the result of a penetrating wound to the abdomen. The left renal vein was in a normal position, anterior to the aorta. Hematuria was less common (16% of cases). The diagnosis was delayed because clinical signs were less acute. There were no reports of postoperative deaths.

Post-traumatic giant fistula between the aorta and the left renal vein: A case report

“…This may explain why the ALRVF was not recognized during the first operation or even several months later. This is not unusual, because similar delays in accurate diagnoses have been reported, ranging from seven days to 17 years (2,3,16). An important clinical sign, although rarely reported, was inexplicable tachycardia during bed rest in the young man, without the presence of cardiovascular disease.…”

“…Pathological communications (fistulas) between the abdominal aorta and the LRV (ALRVF) are extremely rare (1,2,(8)(9)(10). In most cases, such fistulas are found as a complication of aortic aneurysms, mostly when the LRV is in an anomalous retroaortic position, which has been reported in 26 cases so far (8,(11)(12)(13)(14)(15)(16).…”

“…The operative closure of a traumatic ALRVF is considered mandatory (1)(2)(3)(4)(5)(6)(7). Some authors suggest total circulatory arrest and/or profound hypothermia during the procedure, but such techniques may only be necessary in cases with several AV fistulas coupled with an aortic aneurysm, or after unsuccessful repair of traumatic ALRVF (4,5).…”

“…The thoracoabdominal approach gives sufficient access to the ALRVF, the abdominal aorta and the IVC, although total midline laparatomy may also be adequate. A fistulous LRV is easily identified in its anatomical position by its very large dimensions and palpable thrill (2,3,15). Proximal and distal blood control from the aorta is necessary, but it is also very important to control the venous bleeding from the IVC and LRV, which may be severe and even life-threatening, as it was in our case.…”

“…P ost-traumatic fistulas between the aorta and the left renal vein (LRV) are extremely rare -there are only seven reported cases (1)(2)(3)(4)(5)(6)(7). The first report of successfully repaired post-traumatic aorto-LRV fistula (ALRVF) originated from DeBakey et al in 1958 (7).…”