Aorto-Caval Fistula: Successful Management of Two Cases

Two cases of aorto-caval fistula resulting from spontaneous rupture of an aortic aneurysm into the inferior vena cava are described. Although both patients showed the classical signs of a pulsatile abdominal mass with a palpable thrill and a continuous murmur, and the site of the communication was the same in both cases, only the first showed obvious signs of a massive arteriovenous fistula, with a collapsing pulse and severe oliguria promptly cured by correction of the fistula. The second patient illustrates the ability of one elderly patient to survive a series of disasters in aneurysm surgery, namely frank rupture of the aneurysm, high output renal failure, caval thrombosis and intraperitoneal suppuration.