Aortocaval fistula: A rare complication of ruptured abdominal aortic aneurysm

Aortocaval fistula is a rare complication of aortic aneurysm, occurring in approximately 0.2% to 6.04% of all abdominal aortic aneurysms. It may occur in the context of aortic aneurysm rupture, aortitis, Ehlers-Danlos syndrome, Marfan syndrome, or penetrating abdominal trauma. The classic clinical signs are abdominal pain, abdominal thrill, and symptoms of decompensated heart failure. It is usually diagnosed via computed tomography angiography, and typical findings include early contrast enhancement of the inferior vena cava (prior to contrast of the renal and hepatic parenchyma) and retrograde enhancement of the renal or iliac veins. Open surgical treatment has high associated morbidity and mortality, with reported rates of approximately 30%. With the advent of endovascular therapy, these rates have been reduced, with success rates as high as 96%.3. (author)