Abdominal aorta-caval fistula: treatment with aortic and caval synthetic grafts (one year follow-up).

A fistula located between the abdominal aorta and the inferior vena cava is an unusual acquired condition which necessitates prompt diagnosis and, in most instances, emergency surgical repair. The signs and symptoms are related to the size of the shunt. The classical findings are those of a continuous abdominal bruit, edema and venous pooling of the legs, wide pulse pressure, and sudden progressive high-output cardiac failure. Aortography is the definitive diagnostic procedure. However it is impractical in those situations presenting an asymptomatic fistula and contraindicated in presence of signs of progressive renal failure, where emergency surgical treatment is required. In these instances aorta-caval fistula can be correctly diagnosed by means of radionuclide aortography. The fistula can usually be repaired from within the aneurysm after endoarterectomy. Then the aortic graft replacement is completed. In rare cases the pathology at operation is such that this type of repair cannot be performed and an unexpected replacement of the inferior vena cava may be required. The purpose of this paper is to present the description of a patient in whom the diagnosis of aorta-caval fistula was confirmed by means of an isotope angiogram, followed by a successful surgical graft replacement of the abdominal aorta and a dacron tubular graft replacement of the inferior vena cava.