title: Delayed presentation of traumatic aortocaval fistula: a report of two cases and a review of the associated compensatory hemodynamic and structural changes.
abstract: Chronic aortocaval fistula (ACF) is a rare complication of gunshot wounds to the abdomen. Herein we report two cases of traumatic ACF: one asymptomatic and the other presenting with congestive heart failure (CHF) 20 and 30 years, respectively, after their initial injury. The recent onset of CHF, the presence of a continuous abdominal bruit, and, in the second patient, a history of penetrating trauma suggested the diagnosis of ACF. The diagnosis was confirmed by computed tomography scanning in both patients. Surgical repair of the ACF in the symptomatic patient resulted in resolution of the CHF and reversed the dilatation of the aorta and inferior vena cava. The asymptomatic patient was lost to follow-up. CHF in a young male patient with a history of penetrating abdominal trauma should alert the surgeon to this rare complication.
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston 77555-0541, USA.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Spencer
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Smyth
authors.forename: Gerard
authors.initials: G
authors.lastname: Wittich
authors.forename: Glenn C
authors.initials: GC
authors.lastname: Hunter
mesh_terms: D000007:Abdominal Injuries / Q000150:complications*; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D003287:Contrast Media; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D018570:Risk Assessment; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D014682:Vena Cava, Inferior; D014948:Wounds, Gunshot / Q000150:complications*
chemical_list: D003287:Contrast Media