Overview
Aortocaval fistula (ACF) is a rare, abnormal connection between the aorta and the vena cava, often resulting from penetrating abdominal trauma, with delayed presentation possible years after initial injury 1.Diagnosis
Clinical Presentation: Progressive congestive heart failure, abdominal pain, and signs of systemic embolization 1.
Imaging: CT angiography is crucial for diagnosis, visualizing the fistula and hemodynamic impact 1.
Hemodynamic Monitoring: Continuous monitoring of blood pressure and cardiac function essential 1.Management
Endovascular Repair: First-line treatment for chronic ACF using thoracic aortic endoprostheses 1.
Surgical Intervention: Considered if endovascular options are not feasible or fail 1.
Supportive Care: Management of congestive heart failure with standard medical therapy (e.g., diuretics, ACE inhibitors) 1.Special Populations
Delayed Presentation: Chronic ACF can present decades post-trauma, affecting elderly patients more commonly 1.Key Recommendations
Endovascular repair is recommended for chronic aortocaval fistula to address the defect effectively (Evidence: Moderate 1).
Immediate imaging with CT angiography is crucial for diagnosis to guide management decisions (Evidence: Moderate 1).
Supportive medical management for concurrent heart failure should be integrated into the treatment plan (Evidence: Expert opinion 1).References
1 Mitchell ME, McDaniel HB, Rushton FW. Endovascular repair of a chronic aortocaval fistula using a thoracic aortic endoprosthesis. Annals of vascular surgery 2009. link