Aorto-Caval Fistulas: A Review of Eighteen Years Experience

• Published in: Acta chirurgica belgica 2005, Vol.105 (6), p.616-620
• Main Authors: Cinara, I. S., Davidovic, L. B., Kostic, D. M., Cvetkovic, S. D., Jakovljevic, N. S., Koncar, I. B.
• Format: Article
• Language: English
• Subjects: abdominal aortic aneurysm; Aged; Aortic Aneurysm, Abdominal - complications; Aortic Aneurysm, Abdominal - surgery; Aortic Rupture - complications; Aortic Rupture - surgery; Aorto-caval fistulas; Arteriovenous Fistula - diagnosis; Arteriovenous Fistula - etiology; Arteriovenous Fistula - surgery; Biological and medical sciences; Blood Vessel Prosthesis; Diagnostic Imaging; Female; Follow-Up Studies; General aspects; Hemostasis, Surgical - methods; Humans; Iliac Vein - pathology; Iliac Vein - surgery; Male; Medical sciences; Retrospective Studies; Suture Techniques; Treatment Outcome; vena cava inferior; Vena Cava, Inferior - pathology; Vena Cava, Inferior - surgery
• ISSN: 0001-5458
• DOI: 10.1080/00015458.2005.11679788

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 transaor-tic 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.