title: Presentation and treatment of spontaneous aortocaval fistula.
abstract: BACKGROUND
  Spontaneous rupture of abdominal aortic aneurysm into the inferior vena cava is rare. The clinical presentation is highly variable, and the diagnosis can be difficult, often being made only at operation. The aortocaval fistula results in a large left-to-right shunt, which can cause cardiac failure. Once the diagnosis is made, treatment is by surgical closure of the fistula and repair of the aneurysm with a graft.
  
  
  METHODS
  This is a retrospective review of a single surgeon's experience with aortocaval fistula complicating abdominal aortic aneurysms.
  
  
  RESULTS
  Over a 15-year period, we had five patients with spontaneous aortocaval fistula who were treated operatively. Preoperative diagnosis was made in two, suspected in one, and not made in two, one of whom died (the only perioperative death in the series).
  
  
  CONCLUSIONS
  Spontaneous aortocaval fistulas are uncommon, and their preoperative recognition is difficult. Hematuria in association with an abdominal aortic aneurysm should raise the suspicion of an aortocaval fistula. Surgical correction is possible, with survival rates comparable to those associated with rupture of aneurysms into the retroperitoneum. Early operative control of the fistula is important to optimize the preload to the heart.
authors.affiliation: Department of Surgery, West Virginia University School of Medicine, Morgantown, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Skinner
authors.forename: G
authors.initials: G
authors.lastname: Prabhakar
authors.forename: D G
authors.initials: DG
authors.lastname: Genecov
authors.forename: K
authors.initials: K
authors.lastname: Granke
authors.forename: D E
authors.initials: DE
authors.lastname: McDowell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications; D017544:Aortic Aneurysm, Abdominal / Q000150:complications; D001164:Arteriovenous Fistula / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome