Aortoiliac arteriovenous fistula masquerading as deep vein thrombosis

Abstract

Original article can be found at : http://pmj.bmj.com/ Copyright BMJ Publishing Group [Full text of this article is not available in the UHRA]A male smoker in his 60s with hypertension and hyperlipidaemia presented with progressive swelling of his left leg, abdominal discomfort and oliguria. He was obese and had an extensive left deep vein thrombosis (DVT) clinically. Blood tests revealed acute renal failure, and the clinical suspicion was of a urological malignancy causing an obstructive nephropathy and DVT. A CT scan showed a large (9.5??9.8 cm) infra-renal abdominal aortic aneurysm, which had a fistulous connection to the left common iliac vein (fig 1). Retrograde filling of the venous system and obstruction to venous return led to engorgement of the left leg, mimicking a DVT (fig 2). The renal arteries were patent, but contrast was also seen filling the renal veins with no cortical renal enhancement, suggesting retrograde high-pressure flow, with obstruction to venous return and consequent venous infarction, as a mechanism for acute renal failure. The patient rapidly deteriorated, developed multiorgan failure, and died before emergency surgery

Lower Extremity Arteriovenous Fistula Mimicking Deep Venous Thrombosis: A Case Report

“…We found two case reports of patients with no preceding orthopedic surgery presenting with progressive leg swelling and were found to have AVF after clinical suspicion of DVT. One patient developed acute kidney injury due to venous infarction, and the other developed neurological deficits [ 4 , 5 ]. We found several similar case reports with a history of orthopedic surgery.…”

The Physical Examination Does Matter: A Case of Spontaneous Aortocaval Fistula

“…The mechanism of the spontaneous formation of an arteriovenous fistula involves the combination of high arterial wall tension and adventitial inflammation, leading to an adhesion and an erosion of the arterial wall into the vein wall [ 4 ]. In cases of aortocaval fistulas, the high blood flow and venous hypertension may be responsible for pelvic vein arterialization and engorgement, which can cause asymmetric lower extremity edema [ 3 ]. In addition, when complicated by a paradoxical pulmonary embolism, from a mural thrombus [ 5 ] originating in an aneurysmal sac, an erroneous diagnosis of venous thromboembolic disease may be made.…”

“…The prevalence of aortocaval fistulas is one percent of all abdominal artery aneurysms [ 1 ], but the variety of clinical presentations makes early diagnosis challenging [ 2 - 3 ]. We report a case of a spontaneous iliac artery-to-iliac vein fistula presenting with symptoms suggestive of deep venous thrombosis, recurrent pulmonary embolism, and right heart failure.…”