Aortocaval fistula
Updates to Article Attributes
Aorto-caval fistula is a rare and devastating complication of abdominal aortic aneurysm (AAA), wherein the aneurysm the aneurysm erodes into the inferior vena cava.
Epidemiology
Spontaneous rupture of an AAA into the adjacent vena cava occurs in <1% of all aneurysms and in ~3% of ruptured aortic aneurysms 1.
Clinical presentation
The features can be very atypical leading to a delay in diagnosis. The various factors that influence the clinical presentations are the origin, size, location and duration of the fistula:
- high output cardiac failure
- bilateral pedal oedema (venous hypertension in the lower half of body)
- renal insufficiency (reduced renal blood flow)
- haematuria
- continuous bruit
Radiographic features
Aortography is the modality of choice. Colour Doppler, CT and MRI may also demonstrate the same non invasively-invasively. At times, the presence of a mural thrombus may obstruct the fistula.
Treatment and prognosis
Urgent surgical exploration. Operative mortality of spontaneous aorto-cavalaortocaval fistula is about 20 to 55%. The deaths being predominantly due to misdiagnosis or delayed diagnosis.
-<p><strong>Aorto-caval fistula</strong> is a rare and devastating complication of <a href="/articles/abdominal-aortic-aneurysm">abdominal aortic aneurysm</a> (AAA), wherein the aneurysm erodes into the inferior vena cava.</p><h4>Epidemiology</h4><p>Spontaneous rupture of an AAA into the adjacent vena cava occurs in <1% of all aneurysms and in ~3% of ruptured aortic aneurysms <sup>1</sup>.</p><h4>Clinical presentation</h4><p>The features can be very atypical leading to a delay in diagnosis. The various factors that influence the clinical presentations are the origin, size, location and duration of the fistula:</p><ul>- +<p><strong>Aorto-caval fistula</strong> is a rare and devastating complication of <a href="/articles/abdominal-aortic-aneurysm">abdominal aortic aneurysm</a> (AAA), wherein the aneurysm erodes into the inferior vena cava.</p><h4>Epidemiology</h4><p>Spontaneous rupture of an AAA into the adjacent vena cava occurs in <1% of all aneurysms and in ~3% of ruptured aortic aneurysms <sup>1</sup>.</p><h4>Clinical presentation</h4><p>The features can be very atypical leading to a delay in diagnosis. The various factors that influence the clinical presentations are the origin, size, location and duration of the fistula:</p><ul>
-<li>bilateral pedal oedema (venous hypertension in lower half of body)</li>- +<li>bilateral pedal oedema (venous hypertension in the lower half of body)</li>
-</ul><h4>Radiographic features</h4><p>Aortography is the modality of choice. Colour Doppler, CT and MRI may also demonstrate the same non invasively. At times the presence of a mural thrombus may obstruct the fistula.</p><h4>Treatment and prognosis</h4><p>Urgent surgical exploration. Operative mortality of spontaneous aorto-caval fistula is about 20 to 55%. The deaths being predominantly due to misdiagnosis or delayed diagnosis. </p>- +</ul><h4>Radiographic features</h4><p>Aortography is the modality of choice. Colour Doppler, CT and MRI may also demonstrate the same non-invasively. At times, the presence of a mural thrombus may obstruct the fistula.</p><h4>Treatment and prognosis</h4><p>Urgent surgical exploration. Operative mortality of spontaneous aortocaval fistula is about 20 to 55%. The deaths being predominantly due to misdiagnosis or delayed diagnosis. </p>
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