World Journal of Surgery

, Volume 35, Issue 8, pp 1829–1834 | Cite as

Twenty Years of Experience in the Treatment of Spontaneous Aorto-venous Fistulas in a Developing Country

  • Lazar Davidovic
  • Marko DragasEmail author
  • Slobodan Cvetkovic
  • Dusan Kostic
  • Ilijas Cinara
  • Igor Banzic



One of the rare forms of abdominal aortic aneurysm (AAA) rupture is the rupture into great abdominal veins such as the inferior vein cava (IVC), the iliac veins, or the left renal vein, with the formation of direct or indirect aorto-caval fistula (ACF). The purpose of the present study was to summarize 20 years of experience at a single referral center for vascular surgery in a developing country, and to discuss the clinical presentation, diagnosis, treatment options, and outcome of patients with spontaneous aorto-venous fistulas (AVF) caused by ruptured aortic aneurysms.

Materials and methods

Retrospective database review identified 50 patients treated in our institution for aorto-venous fistulas (AVF) caused by spontaneous AAA rupture in the 20 years 1991–2010. Pulsating abdominal mass and low back pain were the leading symptoms on admission in our patients. Signs of shock, congestive heart failure, or pelvic and lower extremity venous hypertension were present in 48%, 26%, and 75% of the patients, respectively. Diagnosis of AVF was based on physical examination, duplex ultrasonography, conventional angiography, or multislice computed tomography (MSCT). In 40% of the patients the presence of AVF has not been recognized before surgery. All patients were treated with open surgery.


After proximal and distal bleeding control the fistula was closed with direct suture (92%) or patch angioplasty (8%). Aortic reconstruction followed with tubular (22%) or bifurcated (78%) synthetic graft. Six (12%) patients died. The causes of death were excessive intraoperative blood loss, myocardial infarction, left colon gangrene and multiple organ failure.


Spontaneous AVFs caused by aneurysmal rupture are not uncommon, and they require prompt surgical or endovascular treatment. Routine use of multislice CT in patients with acute aortic syndrome is probably the best way to the correct diagnosis of aorto-venous fistulas and planning of the optimal treatment.


Abdominal Aortic Aneurysm Abdominal Aortic Aneurysm Duplex Ultrasonography Left Renal Vein Multislice Computerize Tomography 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Lazar Davidovic
    • 1
    • 2
  • Marko Dragas
    • 1
    • 2
    Email author
  • Slobodan Cvetkovic
    • 1
    • 2
  • Dusan Kostic
    • 1
    • 2
  • Ilijas Cinara
    • 1
  • Igor Banzic
    • 1
  1. 1.Clinic for Vascular SurgeryClinical Centre of SerbiaBelgradeSerbia
  2. 2.Faculty of MedicineUniversity of BelgradeBelgradeSerbia

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