Key result
Surgical repair of primary aortocaval fistula associated with abdominal aortic aneurysm, involving fistula closure within the aneurysmal sac and graft replacement, was successfully performed in two patients.
Case Report (n=2)
Preoperative diagnosis and prompt surgical repair of primary aortocaval fistula associated with abdominal aortic aneurysm can lead to successful outcomes despite the high risk of massive bleeding and hemodynamic instability.
Supports feasibility of open repair in rare aortocaval fistula; leaves open optimal approach and generalizability.
Primary aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA), occurring in only 4% of ruptured cases and less than 1% of all AAAs. The hemodynamic changes resulting from the major shunt caused by the ACF include a sudden increase in inferior vena caval pressure and volume with renal venous hypertension and a decrease in total peripheral resistance. So, if untreated, it leads to irreversible high output heart failure. Preoperative diagnosis is crucial, as adequate preparation should be made for massive bleeding expected at operation. Successful treatment depends on management of perioperative hemodynamics, control of bleeding from fistula and prevention of thromboembolism. We report two cases of successfully treated spontaneous ACF with a review of the literature.
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Kim et al. (2009) conducted a case report in Primary aortocaval fistula associated with abdominal aortic aneurysm (n=2). Surgical repair (fistula closure and graft replacement) was evaluated on Successful surgical treatment and survival. Surgical repair of primary aortocaval fistula associated with abdominal aortic aneurysm, involving fistula closure within the aneurysmal sac and graft replacement, was successfully performed in two patients.
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