Preoperative Computed Tomographic Diagnosis of an Aortocaval Fistula Associated with Aneurysm of the Abdominal Aorta

• Published in: Annals of Thoracic and Cardiovascular Surgery Vol. 17; no. 5; pp. 531 - 533
• Main Authors: Oda, Takeshi, Hosokawa, Yukio, Zaima, Yasuyuki, Kawara, Takemi, Nomura, Yoriko, Yasunaga, Hiroshi, Shojima, Takahiro
• Format: Journal Article
• Language: English
• Published: Japan The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery 2011
• Subjects: abdominal aortic aneurysm; Aged; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Aortic Diseases - diagnostic imaging; Aortic Diseases - surgery; aortocaval fistula; Aortography - methods; Arteriovenous Fistula - diagnostic imaging; Arteriovenous Fistula - surgery; Blood Loss, Surgical - prevention & control; Blood Vessel Prosthesis Implantation; computed tomography; Humans; Male; Phlebography - methods; Predictive Value of Tests; Preoperative Care; Tomography, X-Ray Computed; Treatment Outcome; Vena Cava, Inferior - diagnostic imaging; Vena Cava, Inferior - surgery
• ISSN: 1341-1098; 2186-1005; 2186-1005
• DOI: 10.5761/atcs.cr.10.01626

Aortocaval fistula is a rare but life-threatening complication of ruptured abdominal aortic aneurysm. We present a case of an aortocaval fistula with acute right heart failure. The condition was accurately diagnosed before operation by physical examination, echo, and especially by computed tomography (CT), thereby enabling proper planning of the operative strategy. At surgery, not only the infrarenal aorta and common iliac arteries on both sides but the inferior vena cava and iliac veins on both sides were also controlled to avoid massive venous bleeding through the fistula. Aortocaval fistula repair was easy, and conventional bifurcated Dacron graft replacement for abdominal aortic aneurysm was successfully performed. Innovative CT images give us prompt preoperative diagnoses and elaborate surgical strategies.