• Ioannis Kotsikoris, Theofanis T Papas, Nikolaos Papanas, Dimitrios Maras, Maria Andrikopoulou, Nikolaos Bessias, Stamatia Kotsiou, and Efstratios Maltezos.
• Department of Vascular Surgery, Red Cross Hospital, Athens, Greece.
• Vasc Endovascular Surg. 2012 Jan 1;46(1):26-9.

AbstractThis study reports on the frequency and management of aortocaval fistulas (ACFs) in our department between 1998 and 2009. Overall frequency of ACFs among ruptured abdominal aortic aneurysms was 5.5%. Patients presented with low back pain (92.8%), abdominal tenderness (78.6%), hemorrhagic shock (28.6%), congestive heart failure (21.4%), dyspnea (42.8%), and palpitations (57.1%). The most reliable clinical sign was the presence of palpable pulsating abdominal mass (92.8%). Other clinical findings included increased central venous pressure (21.4%), lower extremity edema (71.4%), hematuria (21.4%), and scrotal edema (14.3%). Diagnosis was established preoperatively in 85.7% and intraoperatively in 14.3% of cases. Surgery was successful in promptly improving clinical signs and symptoms. Mortality rate was 7.1%. After a mean follow-up of 18.5 months, all surviving patients remained free from complications. In conclusion, ACFs represent a life-threatening emergency for vascular surgeons but can be successfully managed.

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