[The aortocaval fistula, a rare complication of an aneurysm of the abdominal aorta].
Four patients, 3 men aged 73, 60 and 81 years with hemodynamic instability and 1 man aged 80 with abdominal symptoms and breathlessness appeared to have an arteriovenous fistula secondary to spontaneous rupture of an atherosclerotic aneurysm: between the aorta and the V. cava inferior or between the A. and the left V. iliaca communis. One patient died, one patient had postoperative decompensatio cordis, one suffered a deep vein thrombosis and the 4th recovered without symptoms. The presence of an aortocaval fistula has to be considered in patients with a symptomatic abdominal aneurysm with a harsh bruit heard over the abdomen, signs of high venous pressure and peripheral hypoperfusion. When no rupture of the aneurysm is found at laparotomy in symptomatic patients, the presence of a fistula is rare, but has to be considered. Furthermore, a fistula can be the underlying cause of therapy-resistant heart failure or acute renal dysfunction. Pre-operative identification can lead to decrease of morbidity and mortality of the phenomenon.
Lont
A P
AP
Afd. Chirurgie, Gelre Ziekenhuizen, locatie Lukas, Postbus 9014, 7300 DS Apeldoorn.
Lamme
B
B
Bendien
C
C
Rommes
J H
JH
Rutgers
P H
PH
D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000002:abnormalities*; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000401:mortality / Q000601:surgery; D001019:Aortic Rupture / Q000150:complications / Q000401:mortality / Q000601:surgery; D001164:Arteriovenous Fistula / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000002:abnormalities*