Y. Uemura et al., A UNIQUE METHOD OF CLOSURE FOR AN AORTOCAVAL FISTULA IN ASSOCIATION WITH A RUPTURED ABDOMINAL AORTIC-ANEURYSM - REPORT OF A CASE, Surgery today, 28(11), 1998, pp. 1213-1216
We report herein the case of a 78-year-old man in whom an aortocaval f
istula caused by spontaneous rupture of an abdominal aortic aneurysm (
AAA) was successfully treated by a unique surgical technique, The aort
ocaval fistula had been revealed by an aortography after the patient p
resented,vith high-output heart failure. During the operation, massive
bleeding from the fistula was evident. The fistula measured 2 cm in d
iameter, and was located between the right posterior wall of the AAA a
nd the inferior vena cava (IVC). Direct suturing of the defect in the
IVC failed to close the fistula because the tissue around it would not
hold together due to degeneration. However, the bleeding was finally
able to be controlled by plugging the fistula with isolated and proper
ly trimmed omentum packed within the excluded aneurysmal sac. Unfortun
ately, the patient died due to respiratory failure on the 201st postop
erative day. A pathological autopsy revealed that the aortocaval fistu
la had been closed by fibrous tissue and that the IVC was patent. Alth
ough such a drastic operative measure to repair an aortocaval fistula
has never before been reported, it could be an alternative when direct
closure proves unsuccessful.