Iliocaval fistula with high output cardiac failure

Abstract

Fistulous communications between the common iliac arteries and inferior vena cava are very uncommon and usually occur as a result of trauma, aneurysmal rupture, or endovascular repair. They can present with signs of high output cardiac failure including hypotension, venous congestion, and pulmonary hypertension. This case outlines the utility of CTA in diagnosing iliocaval fistulas and the importance of considering this diagnosis in a patient with signs of right heart strain and high output cardiac failure.

Endovascular Occlusion of Iliocaval Confluence During Surgical Repair of Iliocaval Fistula due to Ruptured Abdominal Aortoiliac Aneurysm

“…Our patient had heart failure, pulmonary edema, and leg swelling due to increased cardiac preload secondary to the large arteriovenous fistula. 7,12…”

“…Aortocaval and iliocaval fistulas are a rare complication of AIAA. They occur in 3-7% of ruptures 1,3,5,6,11,12 and iliocaval fistulas account for approximately 20% of cases. 13 Perioperative mortality is very high, with rates varying from 20-55% 8 to 67% depending on the series.…”

“…Our patient had heart failure, pulmonary edema, and leg swelling due to increased cardiac preload secondary to the large arteriovenous fistula. 7,12 Aortocaval fistulas were first described by Syme et al in 1831, and the first successful surgical repair of an AIAA with an aortocaval fistula was performed by Cooley et al in 1958. 5 The standard surgical technique for ruptured AAA with an aortocaval or iliocaval fistula consists of suturing the fistula from inside the aneurismal sac, followed by aortic reconstruction.…”