Aorto-caval fistulas: a review of eighteen years experience

Acta Chir Belg. Nov-Dec 2005;105(6):616-20. doi: 10.1080/00015458.2005.11679788.

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.

MeSH terms

  • Aged
  • Aortic Aneurysm, Abdominal / complications
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortic Rupture / complications
  • Aortic Rupture / surgery
  • Arteriovenous Fistula / diagnosis*
  • Arteriovenous Fistula / etiology
  • Arteriovenous Fistula / surgery*
  • Blood Vessel Prosthesis
  • Diagnostic Imaging
  • Female
  • Follow-Up Studies
  • Hemostasis, Surgical / methods
  • Humans
  • Iliac Vein / pathology
  • Iliac Vein / surgery*
  • Male
  • Retrospective Studies
  • Suture Techniques
  • Treatment Outcome
  • Vena Cava, Inferior / pathology
  • Vena Cava, Inferior / surgery*