Aortocaval Fistula Associated with Ruptured Abdominal Aortic Aneurysm

Nakazawa, Shozo; Mohara, Jun; Takahashi, Toru; Koike, Norimasa; Takeyoshi, Izumi

doi:10.1016/j.avsg.2014.03.015

Cited by 14 publications

(35 citation statements)

References 19 publications

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“…ACF is spontaneous in 80% of cases, and it occurs in <1% of all AAAs and 3% to 7% of all ruptured AAAs [1,2]. ACF was first reported by Syme in 1831, and the first successful repair was performed by DeBakey and his colleagues in 1954 [3].…”

Section: Discussionmentioning

confidence: 99%

“…The triad of clinical findings of AAA with ACF are abdominal or lower back pain, abdominal machinery bruit, and a pulsating abdominal mass. Other findings include pelvic venous hypertension (hematuria, oliguria, scrotal edema), lower-extremity edema with or without arterial insufficiency or venous thrombus, shock, and congestive heart failure [1–6]. In a previous study, symptoms were found in most patients, but only 17% of the patients had all components of the classic triad of clinical findings.…”

Section: Discussionmentioning

confidence: 99%

“…A precise preoperative diagnosis can be possible if the classic findings are observed, but if these findings are absent or the situation is urgent, the diagnosis may be ambiguous. Contrast-enhanced CT is the gold standard for the diagnosis of AAA [1]. It allows the visualization of several distinctive features of AAA with an ACF.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, wall defects between the aorta and the venous system can be revealed. Other imaging modalities include duplex ultrasonography, angiography, and magnetic resonance angiography [1,3].…”

Section: Discussionmentioning

confidence: 99%

“…The most important aspect of ACF repair is proper control of venous bleeding from the fistula [3]. In order to accomplish this objective, direct manual compression of the areas proximal and distal to the IVC or the insertion of a ballooning catheter into the IVC can be performed [1,3,4]. Surgical methods to close the caval defect include direct suture closure within the aortic lumen or patch closure [1].…”

Section: Discussionmentioning

confidence: 99%

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Surgical Repair of Aortocaval Fistula Presenting with Cardiogenic Shock

Kim

Min

Kim

et al. 2018

Korean J Thorac Cardiovasc Surg

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Aortocaval fistula (ACF) occurs in <1% of all abdominal aortic aneurysms (AAAs), and in 3% to 7% of all ruptured AAAs. The triad of clinical findings of AAA with ACF are abdominal pain, abdominal machinery bruit, and a pulsating abdominal mass. Other findings include pelvic venous hypertension (hematuria, oliguria, scrotal edema), lower-limb edema with or without arterial insufficiency or venous thrombus, shock, congestive heart failure, and cardiac arrest. Surgery is the main treatment modality. We report successful surgical treatment in a patient with a ruptured AAA with ACF who presented with cardiogenic shock.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgical Repair of Aortocaval Fistula Presenting with Cardiogenic Shock

Kim

Min

Kim

et al. 2018

Korean J Thorac Cardiovasc Surg

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Aortocaval Fistula: Is Endovascular Repair the Preferred Solution?

Orion

Beaulieu

Black

2016

Annals of Vascular Surgery

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Background To compare outcomes of open and endovascular repair of aortocaval fistulas (ACFs) in the setting of abdominal aortic aneurysms (AAAs). Methods A literature review was undertaken on Pubmed from 1999 to 2014 to identify reported cases of both endovascular and open repair of ACF, including the index case, presented here. Primary outcomes for endovascular repair were: complications, presence of endoleak, and death. Primary outcomes for open repair were: complications and death. Results Forty articles were reviewed with a total of 67 patients, including the index case. Endovascular approach was used in 26 patients (39%). Endoleaks were present in 50%, whereas similarly 46% of patients had a reported complication. Five deaths (19%) occurred in the endovascular group. Open repair was performed in 41 cases (61%). The rate of complication and the death in open repair were 36% and 12%, respectively (P = 0.327 and P = 0.910, respectively) compared with endovascular. Mean follow-up was 7.7 months for the endovascular group and 8.5 months in the open group. Conclusions Previous demonstrations of high morbidity and mortality with open repair of ACF in the setting of AAA have motivated endovascular approaches. However, endoleaks are a significant problem and were present in 50% of ACF cases. The continued presence of an endoleak in the setting of an ACF may result in persistence of the ACF, unlikely thrombosis of the endoleak, and continued sac enlargement. Endovascular repair presents theoretical benefit, yet is not associated with a reduced rate of complication or death versus open repair in this contemporary review.

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