title: Bilateral long saphenous bruits: a marker of aortocaval fistula.
abstract: BACKGROUND
  The authors present a case of an aortocaval fistula manifesting clinically with bilateral long saphenous bruits. This sign has not been previously described.
  
  
  METHODS
  An 85-year old lady presented with a 3-week history of abdominal pain radiating to her back. Examination revealed a bruit to the right of the midline associated with bilateral long saphenous bruits. A provisional diagnosis of an aortocaval fistula was confirmed on computerised tomography. The fistula was excluded by aortobiiliac bypass and the patient made an uneventful recovery.
  
  
  CONCLUSIONS
  Aortocaval fistulae are rare. They should be suspected if abnormal pulsations are felt to the right of the midline in association with bruits in the region of the inferior vena cava. The presence of long saphenous bruits suggests saphenofemoral incompetence due to arterialised, reversed venous flow dynamics and strengthens the clinical diagnosis of aortocaval fistula.
authors.affiliation: Department of Vascular Surgery, Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
authors.forename: A W
authors.initials: AW
authors.lastname: Phillips
authors.forename: A
authors.initials: A
authors.lastname: Chaudhuri
authors.forename: F J
authors.initials: FJ
authors.lastname: Meyer
mesh_terms: D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging*; D001164:Arteriovenous Fistula / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D012039:Regional Blood Flow; D012501:Saphenous Vein / Q000503:physiopathology*; D013016:Sound; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*