Fístula aortocava como complicación de aneurisma aórtico abdominal / Aortocaval fistula as a complication of abdominal aortic aneurysm

Aortocaval fistula (ACF) is an infrequent complication of abdominal aortic aneurysm (AAA). Diagnosis is suspected by the presence of a continuous abdominal bruit and pulsatile abdominal mass, with variable signs of venous congestion and acute heart failure. Multislice computed tomography (MSCT) is useful in establishing the diagnosis, showing early enhancement of inferior vena cava and, in some cases, identifying the arteriovenous comunication. Surgical treatment is usually complex, with high morbidity and mortality rates. Endovascular treatment seems to be a promising alternative for the management of these patients. We report a case of ACF treated with open surgery and a literature review of this rare condition.

La fístula aortocava (FAC) es una complicación infrecuente del aneurisma aórtico abdominal (AAA). El diagnóstico se sospecha por la detección de un soplo continuo en el hemiabdomen inferior, asociado a masa abdominal pulsátil y signos variables de congestión venosa e insuficiencia cardíaca. La tomografía computada multicorte (TCM) permite confirmar el diagnóstico, evidenciando contraste de la vena cava inferior en fase arterial e identificando la zona anatómica de la comunicación arteriovenosa, en algunos casos. La reparación quirúrgica suele ser compleja, reportándose una alta morbi-mortalidad asociada. El uso de técnicas endovasculares pareciera mejorar el pronóstico de esta entidad. Reportamos un caso de FAC tratado mediante cirugía abierta. Se incluye una revisión de la literatura respecto a esta rara condición.

Primary Aortocaval Fistua Associated with Abdominal Aortic Aneurysm

Primary aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA), occurring in only 4% of ruptured cases and less than 1% of all AAAs. The hemodynamic changes resulting from the major shunt caused by the ACF include a sudden increase in inferior vena caval pressure and volume with renal venous hypertension and a decrease in total peripheral resistance. So, if untreated, it leads to irreversible high output heart failure. Preoperative diagnosis is crucial, as adequate preparation should be made for massive bleeding expected at operation. Successful treatment depends on management of perioperative hemodynamics, control of bleeding from fistula and prevention of thromboembolism. We report two cases of successfully treated spontaneous ACF with a review of the literature.