[Aortocaval fistula secondary to rupture of abdominal aortic aneurysm; report of two cases].

Two cases of aortocaval fistula secondary to rupture of abdominal aortic aneurysm were presented. First case was 70 year old man who was admitted with pulsating abdominal mass. Prior to admission, he had been suffering from congestive heart failure. On physical examination, a pulsating mass, remarkable thrill and continuous bruit were recognized on his abdomen. Aortography showed abdominal aortic aneurysm and aortocaval fistula. The fistula (5mm X 3mm) was repaired within the aneurysm controlling the bleeding from the fistula by the direct digital compression. Aortic reconstruction was done with woven dacron bifurcation graft. Postoperative course was uneventful. Second case was 68 year old man who was admitted with the sudden onset of severe back pain. On admission, his physical status was already deteriorated. Diagnosis was made easily by the physical examination. Immediately after aortography, cardiac arrest occurred suddenly. After resuscitation, he was operated in the same manner of the first case. Large fistula (2 cm X 1cm) was noted. This patient died of renal failure and cerebral damage on 30th post operative day. Problems of pre- and post-operative patient management and surgical therapy for aortocaval fistula secondary to rupture of abdominal aortic aneurysm were discussed.