Aortocaval fistula

Background
  • Complication of abdominal aortic aneurysm
  • Rare (<1% of all AAAs, ~3% of ruptured AAAs) but life-threatening (mortality ~50%)
  • Caused by 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 heart failure
  • Pedal edema (due to venous hypertension)
  • Renal insufficiency (due to reduced perfusion to kidneys)
  • Hematuria
  • Bruit

Differential Diagnosis

Diffuse Abdominal pain

Evaluation
  • US to identify AAA
  • CT angio

Management
  • Treat hypovolemia/shock
  • Emergent surgical repair

Disposition
  • Admit

See Also

References
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