title: Aorto-caval fistulas: a review of eighteen years experience.
abstract: The operative treatment of 26 aorto-caval fistulas during the last 18 years is reviewed (24 male and two female patients; average of 65.3 year). Out of 1698 cases presenting an abdominal aortic aneurysm, 406 presented with rupture, and 26 had aorto caval fistula. In 24 cases (92.3%) it concerned an atherosclerotic aneurysm. One aneurysm with aorto-caval fistula was secondary to abdominal blunt trauma (3.8%), and one due to iatrogenic injury (3.8%). The time interval between first clinical signs of aorto-caval fistula and diagnosis, ranged from 6 hours to 2 years (average 57,3 days). Clinical presentation included congestive heart failure infive patients (11.5%), extreme leg edema in 13 (50.0%), hematuria in 2 (7.0%), renal insufficiency 2 (7.0%), and scrotal edema in six patients. Diagnosis was made by means of color duplex scan in eight patients (30.7%), CT in seven patients (27%), NMR in three patients (11.5%), and angiography in seven patients (27%). Most reliable physical sign was an abdominal bruit,present in 20 patients (77%). In ten patients (38.4%) correct diagnosis was not made prior to surgery. The operative treatment consisted of transaortic suture of the vena cava (25 pts-96.0%), and aneurysm repair. Five operative deaths occurred (19,2%), and for all of them it concerned a misdiagnosis. Cause of death was myocardial infarction (one patient-3.8%), massive bleeding (one patient-3.8%), MOF (two patients-7, 0%), and colon gangrene (one patient-3.8%). Follow-up period varied from six months to 18 years (mean 4 years and two months). Long term results showed a 96% patency rate. No postoperative lower extremity venous insufficiency nor pelvic venous hypertension was observed post-operatively.
authors.affiliation: Institute for Cardiovascular Diseases of the Serbian Clinical Centre, Belgrade, Serbia and Montenegro. ilija.s@eunet.Yu
authors.forename: I S
authors.initials: IS
authors.lastname: Cinara
authors.forename: L B
authors.initials: LB
authors.lastname: Davidovic
authors.forename: D M
authors.initials: DM
authors.lastname: Kostic
authors.forename: S D
authors.initials: SD
authors.lastname: Cvetkovic
authors.forename: N S
authors.initials: NS
authors.lastname: Jakovljevic
authors.forename: I B
authors.initials: IB
authors.lastname: Koncar
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery*; D001019:Aortic Rupture / Q000150:complications / Q000601:surgery; D001164:Arteriovenous Fistula / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D007084:Iliac Vein / Q000473:pathology / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*