Aortocaval fistula

Background

• Complication of abdominal aortic aneurysm
• Rare (<1% of all AAAs, ~3% of ruptured AAAs) but life-threatening (mortality ~50%)
• Inflammation around aorta--> adherence of aorta to vein --> pressure and erosion into vein--> fistula

Clinical Features

• Presentation depends on origin, size, and location of fistula
• Signs/symptoms of AAA (abdominal/flank/back pain, shock if ruptured)
• High output cardiac failure
• Pedal edema (due to venous hypertension)
• Renal insufficiency (due to reduced perfusion to kidneys)
• Hematuria
• Bruit

Evaluation

• US to identify AAA
• CT angio

Management

• Treat hypovolemia/shock
• Emergent surgical repair

Disposition

• Admit

See Also

• [[AAA]