Aortocaval Fistula in a Devastating Abdominal Aneurysm: Case Report and Review of the Literature
Abstract
The presence of fistulas as complications of abdominal aortic aneurysms (AAA) is a known condition, however, infrequent. An incidence of 1 % for aortocaval fistulas (AFC) has been reported in the literature, or even lower values are found in some case series. The aim of this study is to review the literature based on a clinical case to present the diagnostic approach and imaging findings of AFC in order to familiarize readers with the most common characteristics of this entity by computerized tomography. We present the case of a 59-year-old female patient with a clinical picture of four-day evolution abdominal pain, with no relevant history. The abdominal physical examination identified the presence of a pulsatile mass associated with abdominal murmur as the main findings. Abdominal TC angiography assessment identified fusiform aneurysmal dilatation of the abdominal aorta with fistula to the inferior vena cava (VCI), and involvement of the right renal artery with ipsilateral renal hypoperfusion.
Downloads
References
Wadgaonkar AD, Black JH, 3rd, Weihe EK, et al. Abdominal aortic aneurysms revisited: mdct with multiplanar reconstructions for identifying indicators of instability in the pre and postoperative patient. Radiographics. 2015; 35:254-68. DOI: https://doi.org/10.1148/rg.351130137.
Schwartz SA, Taljanovic MS, Smyth S, et al. CT findings of rupture, impending rupture, and contained rupture of abdominal aortic aneurysms. AJR Am J Roentgenol. 2007; 188:57–62. DOI: https://doi.org/10.2214/AJR.05.1554.
Aggarwal S, Qamar A, Sharma V, et al. Abdominal aortic aneurysm: a comprehensive review. Exp Clin Cardiol. 2011; 16:11-15.
Psathas E, Lioudaki S, Doulaptsis M, et al. Clinical manifestations of aortocaval fistulas in ruptured abdominal aortic aneurysm: report of two cases. Case Rep Surg. 2012; 1:123081. DOI: https://doi.org/10.1155/2012/123081.
Singh N, Kuriakose AM, George RA, et al. Computed tomographic diagnosis of aortocaval fistula. S Afr JRad. 2018; 22:1363. DOI: https://doi.org/10.4102/sajr.v22i1.1363.
Ravi R, Peter SB, Swaminathan TS, et al. Spontaneus aortocaval fistula due to abdominal aortic aneurysm rupture – a case report . Indian J Radiol Imaging 2006; 16:453-6.
Rakita D, Newatia A, Hines JJ, et al. Spectrum of CT findings in rupture and impending rupture of abdominal aortic aneurysms. RadioGraphics 2007; 27:497–507. DOI: https://doi.org/10.1148/rg.272065026.
Smillie RP, Shetty M, Boyer AC, et al. Imaging evaluation of the inferior vena cava. Radiographics. 2015; 35:578-592. DOI: https://doi.org/10.1148/rg.352140136.
Gonzales SB, Busquets JC, Figueiras RG, et al. Imaging arteriovenous fistulas. AJR 2009; 193:1425-1433. DOI: https://doi.org/10.2214/AJR.09.2631.
Dabbouseh NM, Mason PJ, Patel PJ, et al. Endovascular repair of delayed traumatic aortocaval fistula. Journal of vascular surgery cases and innovative techniques. 2019; 5: 467-471. DOI: https://doi.org/10.1016/j.jvscit.2019.06.012.
Nakad G, Abi Chedid G, Osman R. Endovascular treatment of major abdominal arteriovenous fistulas: a systematic review. Vasc Endovascular Surg. 2014; 48: 388-395 DOI: https://doi.org/10.1177/1538574414540485.
Patelis N, Giagkos GC, Maltezos K, et al. Aortocaval fistula: an unusual complication of ruptured abdominal aortic aneurysm. bmj Case Rep. 2018 18; 477–480. DOI: https://doi.org/10.1136/bcr-2018-224998.
Orion KC, Beaulieu RJ, Black JH 3rd. Aortocaval Fistula: is endovascular repair the preferred solution? Ann Vasc Surg. 2016;31:221-8. DOI: https://doi.org/10.1016/j.avsg.2015.09.006.
