title: Surgical repair of large aortocaval fistula with limited shunt: Case report.
abstract: A 67-year-old man was admitted with severe back pain and bilateral lower limb swelling. Enhanced computed tomography showed an infrarenal abdominal aortic aneurysm (92 × 75 mm(2)) and a short aortocaval fistula (7 mm). Immediately afterward, circulatory collapse occurred, and the patient was rushed to the operating theater. A much larger aortocaval fistula (22 × 35 mm(2)) than that demonstrated by preoperative computed tomography was found and was repaired with a Dacron patch while using two balloon-tipped catheters to control bleeding. Then, the abdominal aortic aneurysm was replaced with a bifurcated graft. The patient's postoperative course was uneventful. In this case, enhanced computed tomography detected the aortocaval fistula, but could not assess its size accurately. Successful surgical repair of an aortocaval fistula depends on early accurate delineation of the fistula and prompt control of bleeding.
authors.affiliation: Department of Cardiovascular Surgery, JA Nagano Koseiren Shinonoi General Hospital, Nagano, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Gyoten
authors.affiliation: Department of Cardiovascular Surgery, JA Nagano Koseiren Shinonoi General Hospital, Nagano, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Doi
authors.affiliation: First Department of Surgery, University of Toyama, Toyama, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Yamashita
authors.affiliation: First Department of Surgery, University of Toyama, Toyama, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Fukahara
authors.affiliation: Department of Cardiovascular Surgery, Bando Hospital, Toyama, Japan.
authors.forename: Keiju
authors.initials: K
authors.lastname: Kotoh
authors.affiliation: First Department of Surgery, University of Toyama, Toyama, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yoshimura
keywords: Enhanced computed tomography; aortocaval fistula; two balloon-tipped catheters