Aortovenous Fistulas Due to Ruptured Infrarenal Aortic Aneurysms

Fw, Gourdin; Aa, Salam; Rb, Smith; Gd, Perdue

doi:10.1097/00007611-198208000-00003

Cited by 22 publications

(9 citation statements)

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“…Although detection of a distinctive abdominal bruit is the finding most likely to indicate the correct diagnosis, its significance may still be misinterpreted (cases 6,11,12,14). The absence of a palpable pulsatile abdominal mass, typical of those patients with isolated iliac aneurysm rupture or a traumatic fistula, also commonly contributes to lack of recognition, and most such patients often have a much longer clinical course than those with aortocaval fistula.…”

Section: Discussionmentioning

confidence: 99%

“…Occasionally, distended veins of the legs or lower abdomen may be noted to pulsate. Such findings, particularly if largely unilateral (cases 11,15,18) as may occur with an iliac AV fistula, may be confused with venous thrombosis or phlegmasia cerulea dolens. Transmission of such venous hypertension to the pelvic venous system may also lead to hematuria, which may cause diagnostic ,confusion.…”

Section: Discussionmentioning

confidence: 99%

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Aortocaval and iliac arteriovenous fistulas: Recognition and treatment

Brewster

Cambria

Moncure

et al. 1991

Journal of Vascular Surgery

142

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Despite the well characterized physiologic effects of aortocaval or iliac arteriovenous fistulas, patients with such uncommon lesions may manifest a diverse array of symptoms, and diagnosis is often delayed or overlooked. To examine clinical features that facilitate recognition and allow successful repair, a 30-year experience with 20 such fistulas was reviewed. Fourteen fistulas were caused by aneurysm erosion, four followed iatrogenic injury during lumbar disk surgery, and two developed from abdominal gunshot wounds. The interval from presumed occurrence to diagnosis ranged from 3 hours to 8 years. The diagnosis was not recognized before surgery in five (25%) patients. Back pain (70%) was the most common symptom. The presence of a typical abdominal bruit (80%) was the most reliable physical finding, but its significance was occasionally overlooked or misinterpreted. Congestive heart failure was prominent in only seven (35%) patients. Severe lower extremity edema and mottling was the primary manifestation in eight cases, often causing initial confusion with venous thrombosis. Hematuria (5 patients) and oliguric renal failure (4 patients), both fully reversible after fistula repair, also caused diagnostic uncertainty. The mean preoperative cardiac output was 12.2 L/min, falling to 5.4 L/min with fistula repair. Mean blood loss was 5960 ml, supporting use of intraoperative autotransfusion. Two operative deaths (10%) occurred, both in patients not correctly diagnosed before surgery. Despite varied modes of presentation, prompt recognition and use of appropriate operative techniques should achieve successful repair.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Aortocaval and iliac arteriovenous fistulas: Recognition and treatment

Brewster

Cambria

Moncure

et al. 1991

Journal of Vascular Surgery

142

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“…2,3,8,14,26 We report a lower rate at 7.1%. Arguably, the lower mortality rate is, at least in part, attributable to the smaller patient series, which renders percentages less reliable.…”

Section: Discussionmentioning

confidence: 52%

“…Alternatively, there may have been some progress in surgical techniques in comparison to the era of the earlier works. 2,3,8,26 However, 19.2% mortality rate was reported in 2005. 14 In view of this discrepancy, current mortality needs further study by larger population series.…”

Section: Discussionmentioning

confidence: 99%

Aortocaval Fistula Formation due to Ruptured Abdominal Aortic Aneurysms

Kotsikoris

Papas

Παπάνας

et al. 2012

Vasc Endovascular Surg

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This study reports on the frequency and management of aortocaval fistulas (ACFs) in our department between 1998 and 2009. Overall frequency of ACFs among ruptured abdominal aortic aneurysms was 5.5%. Patients presented with low back pain (92.8%), abdominal tenderness (78.6%), hemorrhagic shock (28.6%), congestive heart failure (21.4%), dyspnea (42.8%), and palpitations (57.1%). The most reliable clinical sign was the presence of palpable pulsating abdominal mass (92.8%). Other clinical findings included increased central venous pressure (21.4%), lower extremity edema (71.4%), hematuria (21.4%), and scrotal edema (14.3%). Diagnosis was established preoperatively in 85.7% and intraoperatively in 14.3% of cases. Surgery was successful in promptly improving clinical signs and symptoms. Mortality rate was 7.1%. After a mean follow-up of 18.5 months, all surviving patients remained free from complications. In conclusion, ACFs represent a life-threatening emergency for vascular surgeons but can be successfully managed.

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“…8 The key to diagnosis is suspicion of the complication in every case of AAA likely to have ruptured. 2 Good clinical acumen coupled with timely surgical intervention should salvage all cases of aortocaval fistula. …”

Section: Discussionmentioning

confidence: 99%

Aortocaval Fistula Due to Abdominal Aortic Aneurysm Rupture

Bhat

Neelakandhan

Unnikrishnan

et al. 2000

Asian Cardiovasc Thorac Ann

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Aortocaval fistula is a rare complication of rupture of an aortic aneurysm into the inferior vena cava. Prompt surgical repair is mandatory for salvage. Emergency surgery was performed in 2 cases of aortocaval fistula. The underlying etiology was polyarteritis nodosa in one patient and atherosclerosis in the other. Polyarteritis nodosa leading to abdominal aortic aneurysm with aortocaval fistula is reported for the first time.

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Aortovenous Fistulas Due to Ruptured Infrarenal Aortic Aneurysms

Cited by 22 publications

References 0 publications

Aortocaval and iliac arteriovenous fistulas: Recognition and treatment

Aortocaval and iliac arteriovenous fistulas: Recognition and treatment

Aortocaval Fistula Formation due to Ruptured Abdominal Aortic Aneurysms

Aortocaval Fistula Due to Abdominal Aortic Aneurysm Rupture

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