Spontaneous rupture of an abdominal aortic aneurysm into the inferior vena cava

A 70-yr-old man developed acute localized and generalized symptoms and signs associated with a large aneurysm of the abdominal aorta. During an emergency operation, it was found that the aneurysm had ruptured into the inferior vena cava (IVC). The fistula was closed and the aneurysm replaced by a bifurcated synthetic graft. Important factors in the operative management were: clamping of the aorta above and the common iliac arteries below the aneurysm; opening of the aneurysm through a vertical incision; control of back bleeding through the fistula by external pressure on the IVC; closure of the fistula by a continuous braided dacron suture incorporating the walls of the aneurysm and the IVC; and replacement of the aneurysm by a bifurcated synthetic graft without excision of the aneurysm.