Aortocaval fistula in ruptured aneurysms

Objectives: to study incidence, clinical presentation and problems in manag ement of aortocaval fistula in our series. Design: retrospective study. Materials: during a seven-year period, 112 patients operated on for abdomin al aortic aneurysm, including four patients with aortocaval fistula. Methods: standards repair of aortocaval fistula from inside the aneurysmal sac was the preferred operative technique. Results: the incidence of aortocaval fistula was 3.6%. Three cases were fou nd incidentally during emergency surgery for ruptured aneurysms; the fourth case was an isolated aortocaval fistula associated with inferior vena cava thrombosis, diagnosed preoperatively by angiography. In this case, inferio r vena cava ligation instead of standard aortocaval repair was performed. Conclusions: Aortocaval fistulas, although rare, should be keep in mind, be cause clinical diagnosis is often difficult. Furthermore, unsuspected probl ems during repair may necessitate appropriate change in operative technique .