Arteriovenous Fistula From Rupture of Abdominal Aortic Aneurysm

Two patients with spontaneous aortocaval fistulas are described and compared with 67 cases reported in the English literature. Symptoms may vary widely; however, the presence of an expansile abdominal mass with a continuous bruit is usually diagnostic. The only successful management is prompt repair of the vena caval defect and the aortic aneurysm. A third patient with spontaneous rupture of an abdominal aortic aneurysm into the left renal vein is also described. Only five similar cases could be found in the world literature. Left flank pain, pulsatile abdominal mass, continuous bruit, and hematuria is the usual clinical picture. All of these cases involved an anomalous left retroaortic renal vein and all patients survived the necessary surgical correction. The operation of choice is closure of the defect in the retroaortic left renal vein and repair of the aneurysm.