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Primary aortocaval fistula

G Ghilardi1, R Scorza, E Bortolani

  • 1Istituto di Chirurgia Generale e Cardiovascolare dell'Università degli Studi di Milano, Italy.

Cardiovascular Surgery (London, England)
|August 1, 1994
PubMed
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Spontaneous aortocaval fistulas are rare complications of abdominal aortic aneurysms. Surgical repair has a high mortality, especially in shocked patients, with endoaneurysmal repair being the primary method.

Area of Science:

  • Vascular Surgery
  • Aortic Aneurysm Research

Background:

  • Spontaneous aortocaval fistulas (ACFs) are uncommon but serious complications.
  • They occur between abdominal aortic aneurysms (AAAs) and the inferior vena cava (IVC).

Purpose of the Study:

  • To analyze the surgical outcomes and mortality rates of patients with spontaneous ACFs.
  • To compare outcomes based on patient's shock status and blood replacement strategies.

Main Methods:

  • Retrospective review of 22 patients surgically treated for spontaneous ACFs over 27 years.
  • Surgical approach involved endoaneurysmal repair with Dacron prosthesis after controlling venous bleeding.
  • Analysis of mortality rates in relation to preoperative shock and intraoperative autotransfusion.

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Main Results:

  • Operative mortality was 36.4%, comparable to ruptured AAAs (34.9%).
  • Patients in shock on admission had a 50% mortality rate versus 25% for non-shocked patients.
  • Intraoperative autotransfusion did not improve mortality and was associated with higher shock incidence.

Conclusions:

  • Surgical repair of spontaneous ACFs carries significant risk, particularly for shocked patients.
  • Endoaneurysmal repair is the standard procedure, but outcomes remain challenging.
  • Autotransfusion strategies did not demonstrate a survival benefit in this cohort.