Successful open surgical repair of large ilio-caval fistula presenting with congestive heart failure

Area of Science:

• Vascular Surgery
• Cardiovascular Surgery
• Interventional Radiology

Background:

• Ilio-caval arteriovenous fistula is a rare complication following lumbar disc surgery or penetrating trauma.
• Patients may present with symptoms of congestive heart failure and abdominal murmurs.

Observation:

• A 40-year-old male presented with congestive heart failure symptoms and a continuous murmur over the right iliac fossa.
• A history of two lumbar disc surgeries one year prior was noted.
• Computed tomography angiogram revealed a large arteriovenous fistula between the right common iliac artery and the inferior vena cava.

Findings:

• The arteriovenous fistula was deemed unsuitable for endovascular repair.
• Open surgical repair was performed, involving ligation of the right common iliac artery proximal and distal to the fistula.
• Continuity was restored using an interposition Dacron graft.

Implications:

• Open surgical repair is a viable and effective treatment for complex ilio-caval arteriovenous fistulas not amenable to endovascular methods.
• Successful surgical management can lead to complete symptom resolution and good long-term outcomes.
• This case highlights the importance of considering lumbar surgery as a potential cause for ilio-caval arteriovenous fistulas.