Fistulas between the aorta and the left renal vein

Two cases of aorta-left renal vein fistula (ALRVF) resulting from abdominal aortic aneurysm (AAA) are reported. A review of the literature reveals only 10 other such cases. Clinical presentation included left flank pain in 75% of cases, hematuria in 92%, hypotension in 8%, a pulsatile mass in 58%, and an abdominal bruit in 75%. Intravenous pyelography was performed in 58% of cases and consistently showed decreased function of the left kidney. Arteriography was obtained in 58% of patients and was always diagnostic. Incidence, pathophysiology, and surgical management of this condition are discussed.