• M von Heesen, J Sperling, T Plusczyk, A Bücker, M Katoh, M K Schilling, and M R Moussavian.
• Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie.
• Dtsch. Med. Wochenschr. 2010 Nov 1;135(46):2296-9.

History And Admission FindingsA 71-year-old patient had been referred to our hospital with the diagnosis, made by angio-computed tomography (CTA), of a covered ruptured abdominal aortic aneurysm (AAA) resulting in an aortocaval fistula (ACF).InvestigationsThe physical examination revealed macrohematuria and high-output heart failure with increasing circulatory insufficiency.Diagnosis, Treatment And CourseAn open endovascular procedure was not possible because the AAA had extended into both internal iliac arteries. A bifurcated prosthesis connecting to both femoral arteries was then successfully implanted and the infrahepatic aortocaval fistula closed by a patch through the AAA. Ischemic colitis, diagnosed on postoperative day 2 (POD 2), was successfully treated with antibiotics. CTA, done on POD 5, revealed a small residual ACF, filling retrogradely from the right external iliac artery via the surgically closed aneurysmal sack. Closure of the residual ACF was achieved with an Amplatz occluder inserted into the right external iliac artery, introduced percutaneously via the right femoral artery. The postoperative course was uneventful and the patient discharged on POD 13.ConclusionThe coincidence of AAA and ACF is rare. However, the morbidity and mortality are high and require early diagnosis and immediate treatment.© Georg Thieme Verlag KG Stuttgart · New York.

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