CASE HISTORY – April 2021

Aortocaval fistula. A case report and a literature overview

Authors: Solveig Verbu, Kaarel Kärmas, Tiit Kivistik, Priit Põder

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Aortocaval fistula (ACF) is a rare complication of an abdominal aortic aneurysm (AAA), which has always lethal outcome without surgical intervention. The nature of the disease is that an AAA erodes into the wall of the inferior vena cava, resulting in the formation of a fistula between the vessels. ACF can present as cardiac insufficiency and renal insufficiency caused mainly by hyperdynamic blood flow. It meets the criteria for surgical treatment in the case of peripheral venous insufficiency and the radiology result confirming presence of AAA.

The first choice in radiographic imaging is magnetic resonance angiography or computed tomography angiography. The only treatment option available is surgical intervention, taking into account that the diagnosis is time critical: the more prompt and correct is the diagnosis, the lower is mortality rate.

An illustrative overview is presented of a case of a 69-year-old woman with a ruptured AAA and ACF. The patient was successfully treated by an open surgical repair. The ACF was repaired primarily within sack and AAA was replaced by an 18mm linear Dacron graft.