PRESENTATION AND TREATMENT OF SPONTANEOUS AORTOCAVAL FISTULA

Background. Spontaneous rupture of abdominal aortic aneurysm into the inferior vena cava is rare. The clinical presentation is highly variab le, and the diagnosis can be difficult, often being made only at opera tion. The aortocaval fistula results in a large left-to-right shunt, w hich can cause cardiac failure. Once the diagnosis is made, treatment is by surgical closure of the fistula and repair of the aneurysm with a graft. Methods. This is a retrospective review of a single surgeon's experience with aortocaval fistula complicating abdominal aortic aneu rysms. Results. Over a 15-year period, we had five patients with spont aneous aortocaval fistula who were treated operatively Preoperative di agnosis was made in two, suspected in one, and riot made in two, one o f whom died (the only perioperative death in the series). Conclusions. Spontaneous aortocaval fistulas are uncommon, and their preoperative recognition is difficult. Hematuria in association with an abdominal a ortic aneurysm should raise the suspicion of an aortocaval fistula. Su rgical correction is possible, with survival rates comparable to those associated with rupture of aneurysms into the retroperitoneum. Early operative control of the fistula is important to optimize the preload to the heart.