Aortocaval Fistula Unmasked: Spotting the Silent Threat in Emergency Vascular Imaging
DOI:
https://doi.org/10.32896/tij.v5n3.20-24Keywords:
aortocaval fistula, aortic abdominal aneurysm, aortic ruptureAbstract
Aortocaval fistula (ACF) constitutes a rare but severe vascular complication of abdominal aortic aneurysm (AAA), characterized by the formation of an anomalous arteriovenous communication between the aorta and the inferior vena cava. This report presents the case of a 67-year-old male with underlying cardiovascular comorbidities who presented with progressive abdominal pain and hemodynamic compromise. Computed tomography angiography (CTA) revealed a large infrarenal AAA with synchronous contrast opacification of the aorta and inferior vena cava, consistent with an ACF. Definitive management via open surgical repair was undertaken, resulting in a favorable postoperative course. This case report aims to explore the various imaging modalities used in the detection of aortocaval fistula (ACF) and their clinical applicability. Among the available imaging modalities, CT angiography remains the gold standard due to its rapid acquisition, broad accessibility, and high sensitivity and specificity.
References
Delbare, F., Leenknegt, B., & Vanhoenacker, P. (2023). Aortocaval fistula: A rare complication of an infrarenal aortic aneurysm. Journal of the Belgian Society of Radiology, 107(1), Article 30. https://doi.org/10.5334/jbsr.3099
Singh, N., Kuriakose, A. M., George, R. A. N., & Vaidya, S. (2018). Computed tomographic diagnosis of aortocaval fistula. SA Journal of Radiology, 22(1), a1363. https://doi.org/10.4102/sajr.v22i1.1363
Krishna, K., Izan, M. G. K., Lenny, S., Azim, I., & Harunarashid, H. (2016). Heart failure as a presentation of abdominal aortic aneurysm caused by the presence of aortocaval fistula. Malaysian Journal of Emergency Medicine, 1(2), Supplementary Issue. Retrieved from https://www.m-jem.com/index.php/mjem/article/view/103
Gulati, A., Kapoor, H., Donuru, A., Gala, K., & Parekh, M. (2021). Aortic fistulas: Pathophysiologic features, imaging findings, and diagnostic pitfalls. RadioGraphics, 41(5), 1335–1351. https://doi.org/10.1148/rg.2021210004
Esmat, H. A., & Naseri, M. W. (2021). Endovascular management of aortocaval fistula complicating abdominal aortic aneurysm presenting as an acute renal failure. Annals of Medicine and Surgery, 62, 477–480. https://doi.org/10.1016/j.amsu.2021.01.090
Sohail, A. H., Cohen, K., Ho, K., Cimaroli, S., Brathwaite, C. E. M., & Shin, P. (2023). Incidental aortocaval fistula in the setting of an unruptured abdominal aortic aneurysm. Journal of Surgical Case Reports, 2023(7), rjad384. https://doi.org/10.1093/jscr/rjad384
Tack, D., Muller, P., Wéry, D., & Delcour, C. (2002). Aortocaval fistula. Eurorad, Case 1487. https://doi.org/10.1594/EURORAD/CASE.1487
Walter F, Blum A, Quirin-Cosmidis I, Bauer P, Pinelli G, Roland J. An aortocaval fistula diagnosed with 1.5-T magnetic resonance angiography. J Cardiovasc Magn Reson. 2000;2(3):213-6. doi: 10.3109/10976640009146570. PMID: 11545119.
Kumar, Yogesh & Hooda, Kusum & Li, Shuo & Goyal, Pradeep & Adeb, Melkamu. (2017). Abdominal aortic aneurysm: Pictorial review of common appearances and complications. Annals of Translational Medicine. 5. 10.21037/atm.2017.04.32.
Torigian, D.A., Carpenter, J.P. and Roberts, D.A. (2002), Mycotic aortocaval fistula: Efficient evaluation by bolus-chase MR angiography. J. Magn. Reson. Imaging, 15: 195-198. https://doi.org/10.1002/jmri.10026
Spencer TA, Smyth SH, Wittich G, Hunter GC. Delayed presentation of traumatic aortocaval fistula: a report of two cases and a review of the associated compensatory hemodynamic and structural changes. J Vasc Surg. 2006 Apr;43(4):836-40. doi: 10.1016/j.jvs.2005.12.003. PMID: 16616246.
Esmat, H. A., & Naseri, M. W. (2021). Endovascular management of aortocaval fistula complicating abdominal aortic aneurysm presenting as an acute renal failure. Annals of Medicine and Surgery, 62, 477–480. doi:10.1016/j.amsu.2021.01.090
González, S. B., Busquets, J. C. V., Figueiras, R. G., Martín, C. V., Pose, C. S., de Alegría, A. M., & Mourenza, J. A. C. (2009). Imaging Arteriovenous Fistulas. American Journal of Roentgenology, 193(5), 1425–1433. doi:10.2214/ajr.09.2631
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
