Related Experiment Videos
Aortocava fistula: experience with five patients
L Sigler1, R Gutiérrez-Carreño, C Martínez-López
1Vascular Service and Surgical Division, Hospital de Especialidades, Centro Médico Nacional Siglo XXI del IMSS, Mexico City, Mexico. l.sigler@starmedia.com
Vascular Surgery
|July 14, 2001
Summary
Rare aortocaval fistulas after penetrating trauma can cause high-output heart failure. Prompt diagnosis and surgical repair are crucial for survival and preventing further cardiac damage in these complex vascular injuries.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Cardiology
Background:
- Combined injuries to the aorta and inferior vena cava are infrequent but carry a high mortality rate, primarily due to hemorrhage.
- Survivors of penetrating trauma may develop post-traumatic aortocaval fistulas, presenting with high-output heart failure in the postoperative period.
Purpose of the Study:
- To review cases of aortocaval fistulas following abdominal penetrating injuries.
- To analyze the clinical presentation, management, and outcomes of patients with these rare vascular injuries.
Main Methods:
- Retrospective review of five male patients (ages 9-39) with aortocaval fistulas after abdominal penetrating injuries.
- Patients presented with congestive heart failure 2 days to 6 months post-injury and prior surgery at another facility.
Main Results:
- Four patients with infrarenal fistulas (gunshot injuries) survived surgical repair; one had a concomitant popliteal artery embolism.
- One patient with a suprarenal fistula (stab injury) died during surgery due to severe congestive heart failure.
- Aortocaval fistulas can develop with communicating pseudoaneurysms, leading to high-output heart failure.
Conclusions:
- High-output heart failure in patients with a history of abdominal penetrating injury should raise suspicion for an arteriovenous fistula.
- Arteriography is essential for diagnosing and locating the fistula.
- Surgical intervention is necessary to prevent progressive cardiac damage; endovascular techniques may offer future treatment options.