Ruptured Infrarenal Abdominal Aortic Aneurysm with Aortocaval Fistula: Open Surgical Repair and Clinical Outcome

Abdoul Aziz Thiaw; Ndeye Fatou Sow; Abdou Lahat Mbengue; Moussa Mareme Samba; Papa Amath Diagne; Momar Sokhna Diop; Dialtabe Ibrahima Ba; Mory Camara; Abdou Khoudouss Diallo; Mareme Soda Mbaye; Moussa Seck Diop; Anta Mbaye Sall; Cheikh Abdou Khadre Faye; Amadou Dioulde Diallo; Pape Ousmane Ba; Magaye Gaye; Souleymane Diatta; Papa Salmane Ba; Papa Adama Dieng; Amadou Gabriel Ciss

doi:doi:10.11648/j.ijcts.20261202.18

Case Report |

| Peer-Reviewed

Ruptured Infrarenal Abdominal Aortic Aneurysm with Aortocaval Fistula: Open Surgical Repair and Clinical Outcome

Abdoul Aziz Thiaw^*

, Ndeye Fatou Sow

, Abdou Lahat Mbengue, Moussa Mareme Samba

, Papa Amath Diagne

, Momar Sokhna Diop, Dialtabe Ibrahima Ba, Mory Camara, Abdou Khoudouss Diallo, Mareme Soda Mbaye, Moussa Seck Diop, Anta Mbaye Sall, Cheikh Abdou Khadre Faye

, Amadou Dioulde Diallo, Pape Ousmane Ba, Magaye Gaye, Souleymane Diatta, Papa Salmane Ba, Papa Adama Dieng, Amadou Gabriel Ciss

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 12, Issue 2)

Received: 7 March 2026 Accepted: 16 March 2026 Published: 28 March 2026

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Abstract

Background: Aortocaval fistula (ACF) is a rare but life-threatening complication of abdominal aortic aneurysm (AAA), occurring in approximately 1% of all AAAs and up to 6% of ruptured cases. It results from progressive erosion of the aneurysmal wall into the inferior vena cava, creating a pathological arteriovenous communication that may lead to high-output cardiac failure, venous hypertension, and renal dysfunction. Because clinical manifestations are highly variable, diagnosis is often delayed. Computed tomography angiography remains the diagnostic modality of choice, allowing visualization of early venous opacification and characterization of aneurysm morphology. Case Presentation: We report the case of a 65-year-old woman presenting with acute abdominal pain and exertional dyspnea. CT angiography demonstrated a 68-mm infrarenal ruptured AAA with early opacification of the inferior vena cava, confirming an ACF. Despite the rupture, the patient remained hemodynamically stable, with preserved renal function and normal laboratory parameters. Management: Emergency open surgical repair was performed through a midline laparotomy. After proximal and distal vascular control, the aneurysm sac was opened, revealing a large fistulous defect on the right posterolateral aortic wall. The venous defect was closed with interrupted sutures, followed by an aortobi-iliac bypass using a bifurcated prosthetic graft. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 8. At 30-day follow-up, she remained asymptomatic, and Doppler ultrasound confirmed graft patency without residual arteriovenous communication. Conclusion: Aortocaval fistula remains an uncommon but severe complication of infrarenal AAA. Early recognition and prompt surgical intervention are essential to reduce morbidity and mortality. While endovascular repair is an emerging alternative in selected patients, open repair continues to be the standard approach in many settings, particularly where endovascular resources are limited or when the fistula is large or anatomically complex.

Published in	International Journal of Cardiovascular and Thoracic Surgery (Volume 12, Issue 2)
DOI	10.11648/j.ijcts.20261202.18
Page(s)	70-74
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Aortocaval Fistula, Abdominal Aortic Aneurysm, Aneurysm Rupture, Open Surgical Repair, Endovascular Aneurysm Repair

1. Introduction

Aortocaval fistula (ACF) is an uncommon but life-threatening complication of abdominal aortic aneurysm (AAA), first described by Syme in 1831. Although AAA is relatively frequent in elderly populations, ACF remains rare, with an incidence estimated at 1% among patients with AAA and up to 6% in cases of ruptured aneurysm

[1, 2]

. The condition arises when progressive aneurysmal expansion leads to erosion of the aortic wall into the adjacent inferior vena cava (IVC), creating a pathological arteriovenous communication.

The pathophysiology of ACF involves a combination of mechanical pressure, chronic inflammation, and weakening of the aortic wall. Once the fistula forms, arterial blood flows directly into the low-pressure venous system, resulting in abrupt increases in venous return, preload, and cardiac output. This may lead to high-output cardiac failure, venous hypertension, renal dysfunction, and pulmonary hypertension

[3, 4]

The clinical presentation is notoriously variable. Although the classic triad—abdominal pain, pulsatile mass, and continuous abdominal bruit—is well known, it is present in fewer than half of cases

[5]

. Many patients instead present with nonspecific symptoms such as dyspnea, lower-limb edema, hematuria, or signs of heart failure. This variability contributes to diagnostic delays and worsens prognosis.

CT angiography has become the diagnostic modality of choice, allowing visualization of the fistulous tract, early opacification of the IVC, and assessment of aneurysm morphology

[6]

. Early diagnosis is crucial, as mortality remains high, ranging from 7% to 50% depending on hemodynamic status and treatment modality

[2, 7]

Although EVAR has emerged as a promising alternative with lower perioperative morbidity, open surgical repair remains the standard of care in many regions, particularly where endovascular resources are limited or when the fistula is large or anatomically complex

[3, 8]

. We report a case of ruptured infrarenal AAA with ACF successfully treated by open aortobi-iliac bypass, with an excellent postoperative outcome.

2. Case Report

Download: Download full-size image

Figure 1. CT angiography revealed A 68mm infrarenal AAA; retroperitoneal rupture; opacification of the IVC and iliac veins during the arterial phase.

A 65-year-old woman presented to the emergency department with sudden onset of periumbilical abdominal pain radiating to the back, associated with exertional dyspnea for approximately four hours. Her medical history included hypertension, type 2 diabetes, dyslipidemia, and hypothyroidism, all medically controlled. She had no history of smoking or known vascular disease.

Clinical examination

On admission, she was conscious, oriented, and hemodynamically stable.

Blood pressure: 117/63 mmHg; Heart rate: 67 bpm

Respiratory rate: 18/min; Oxygen saturation: 98% on room air

Abdominal examination revealed obesity and right flank tenderness without guarding or rebound. No pulsatile mass was palpable due to body habitus. Peripheral pulses were present and symmetrical. There were no signs of heart failure or lower-limb edema.

Laboratory findings

All laboratory values were within normal limits:

Hemoglobin: 12.4 g/dL; White blood cell count: 7,800/mm³

Platelets: 245,000/mm³; Serum creatinine: 0.9 mg/dL

Lactate: 1.4 mmol/L; Coagulation profile: normal

These results suggested preserved hemodynamic compensation despite the underlying rupture.

CT angiography revealed:

A 68mm infrarenal AAA; Retroperitoneal rupture; Early opacification of the IVC and iliac veins during the arterial phase. These findings confirmed the diagnosis of ACF.

Surgical Management

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Figure 2. Aortobi-iliac bypass after venous breach closure.

The patient underwent emergency open repair under general anesthesia. Through a midline laparotomy, the aneurysm was exposed, and proximal and distal vascular control was obtained. After opening the aneurysm sac, a large fistulous defect was identified on the right posterolateral wall of the aorta communicating with the IVC.

The venous defect was closed using interrupted 5-0 Vicryl sutures, after digital compression of the venous breach. Aortobi-iliac bypass grafting was performed using a bifurcated prosthesis. Estimated blood loss was 900 mL, requiring transfusion of three units of packed red blood cells.

Postoperative course

The patient was admitted to the intensive care unit for four days. Hemodynamic parameters remained stable, and renal function was preserved. She was transferred to the surgical ward on postoperative day 5 and discharged home on day 8.

At 30-day follow-up, she exhibited good clinical recovery, with appropriate wound healing. Doppler ultrasound demonstrated a patent aortic graft with triphasic flow and no residual arteriovenous communication.

3. Discussion

Aortocaval fistula is a rare but severe complication of ruptured AAA, occurring in 3–4% of cases

[7]

. The IVC is the most commonly involved venous structure due to its close anatomical proximity. The pathogenesis involves chronic mechanical pressure, inflammatory degradation of the aortic wall, and eventual erosion into the venous system

[9]

Clinical presentation and diagnostic challenges:

The clinical manifestations of ACF are diverse. High-output cardiac failure may occur due to increased preload, while venous hypertension can lead to lower-limb edema, varicosities, or deep venous thrombosis. Renal dysfunction may result from venous congestion or reduced renal perfusion

[10]

. Pulmonary hypertension and embolic events have also been reported.

Because these signs are nonspecific, preoperative diagnosis is achieved in only 30–50% of cases

[5]

. CT angiography is the diagnostic modality of choice, with key findings including early opacification of the IVC during the arterial phase, loss of the fat plane between the aorta and IVC, and visualization of the fistulous tract

[6]

Management considerations

Open surgical repair has long been the standard treament. The Society for Vascular Surgery (SVS) guidelines also emphasize that open repair remains the preferred approach in complex situations such as rupture or associated fistula, where direct control of the venous defect is required

[11]

. It allows direct closure of the fistula and replacement of the aneurysmal segment. However, the procedure is technically demanding due to the risk of massive bleeding, hemodynamic instability, and abrupt changes in preload following shunt interruption

[2]

EVAR has emerged as a less invasive alternative, particularly in high-risk patients

[3, 12]

. Several reports have demonstrated successful exclusion of the aneurysm and reduction of shunt flow. However, complete closure of the fistula is not always achieved, and persistent arteriovenous communication may require secondary intervention

[13]

. Greenberg et al also highlighted that EVAR can be considered even anatomically challenging situation, provided that careful planning and advanced endovascular expertise are available, although complete fistula exclusion is not always guaranteed

[14]

Comparison with published cases

Most published cases describe patients presenting with hemodynamic instability, renal impairment, or signs of heart failure

[1, 7]

. In contrast, our patient presented with preserved vital signs and normal laboratory parameters, highlighting the variability of clinical presentation. Early diagnosis and rapid surgical intervention likely contributed to the favorable outcome.

Table 1. Comparison of our case with the main series and case reports published on aortocaval fistulas.

Study / Reference

Number of cases

Mean age

Dominant clinical presentation

Preoperative diagnosis

Treatment

Mortality

Brewster et al., 1991

[1]

67 years

Heart failure, abdominal pain

50%

Open repair

22%

Davidovic et al., 2005

[2]

64 years

Pain, shock, continuous bruit

48%

Open repair

28%

Saers & Scheltinga, 2005

[4]

81 (review)

65 years

Classic triad <50%

40–50%

Open repair

30–50%

Antoniou et al., 2009

[3]

69 years

Heart failure, pain

55%

EVAR

10–15%

Hinchliffe et al., 2002

[

8 ]

71 years

Heart failure

67%

EVAR

Kopp et al., 2002

[7]

68 years

Pain, hypotension

43%

Open repair

29%

Sohail et al., 2023

5 ]

73 years

Incidental ACF in unruptured AAA, minimal symptom

100%

EVAR

Gomes et al., 2023

6 ]

Abdominal pain, heart failure signs, ruptured AAA

100%

EVAR

Vaz Dias et al., 2024

7 ]

Generalized edema, dyspnea, abdominal pain,

100%

EVAR

Oderich et al., 2010 (case series, endovascular caution)

8 ]

65-78 years

Heart failure, abdominal pain, high-output state

67%

EVAR

0 – 33%

Present case

65 years

Acute abdominal pain, exertional dyspnea

100%

Open repair

Compared with recent reports favoring EVAR in high-risk or elderly patients

[1-4]

, our experience supports the continued role of open repair as a definitive option, particularly where endovascular facilities are limited or when direct fistula closure is deemed necessary.

4. Conclusion

Aortocaval fistula is a rare but severe complication of infrarenal AAA. Its diagnosis may be challenging due to variable clinical presentation. Open surgical repair remains the standard treatment in many settings, particularly where endovascular options are limited. The growing use of EVAR reflects its potential advantages, although long-term outcomes and indications continue to be refined.

Abbreviations

AAA	Abdominal Aortic Aneurysm
ACF	Aortocaval Fistula
AVF	Arteriovenous Fistula
BP	Blood Pressure
CT	Computed Tomography
CTA	Computed Tomography Angiography
DVT	Deep Venous Thrombosis
EVAR	Endovascular Aneurysm Repair
HF	Heart Failure
HR	Heart Rate
ICU	Intensive Care Unit
IVC	Inferior Vena Cava
POD	Postoperative Day
RR	Respiratory Rate
SpO₂	Peripheral Oxygen Saturation

Author Contributions

Abdoul Aziz Thiaw: Conceptualization, Data curation, Formal Analysis, Funding acquisition, Investigation, Methodology, Writing – original draft, Writing – review & editing

Ndeye Fatou Sow: Funding acquisition, Project administration, Resources, Supervision, Validation

Abdou Lahat Mbengue: Methodology, Software, Validation, Visualization

Papa Adama Dieng: Formal Analysis, Validation, Visualization

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Brewster DC, Cambria RP, Moncure AC, Darling RC, LaMuraglia GM, Geller SC. Aortocaval and iliac arteriovenous fistulas: recognition and treatment. J Vasc Surg. 1991; 13(2): 253-64. https://doi.org/10.1016/0741-5214(91)90218-J
[2]	Davidovic LB, Markovic DM, Kostic DM, Maksimovic Z, Cinara IS, Markovic M. Aortocaval fistulas: a review of 25 patients. Cardiovasc Surg. 2002; 10(6): 530-5. https://doi.org/10.1016/S0967-2109(02)00106-0
[3]	Antoniou GA, Koutsias S, Karathanos C, Sfyroeras GS, Vretzakis G, Giannoukas AD. Endovascular stent-graft repair of major abdominal arteriovenous fistula: a systematic review. J Endovasc Ther. 2009; 16(4): 514-23. https://doi.org/10.1583/09-2763.1
[4]	Saers SJ, Scheltinga MR. Aortocaval fistula: a rare complication of an abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 2005; 30(4): 429-37. https://doi.org/10.1016/j.ejvs.2005.06.003
[5]	Tellez L, Cervera R, Esteban E, Martínez-Sánchez P, García-García A, Castañer E. Aortocaval fistula: clinical features and CT findings. Emerg Radiol. 2012; 19(4): 341-5. https://doi.org/10.1007/s10140-011-1003-4
[6]	Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, et al. ESVS 2019 Clinical Practice Guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg. 2019; 57(1): 8-93. https://doi.org/10.1016/j.ejvs.2018.09.020
[7]	Kopp R, Wizgall I, Kreuzer E, Meimarakis G, Weidenhagen R, Kühnl A. Aortocaval fistula: an uncommon complication of infrarenal aortic aneurysms. Vasa. 2002; 31(3): 195-9. https://doi.org/10.1024/0301-1526.31.3.195
[8]	Hinchliffe RJ, Braithwaite BD, Hopkinson BR. The management of aortocaval fistula by endovascular stent-grafting. Eur J Vasc Endovasc Surg. 2002; 23(5): 475-6. https://doi.org/10.1053/ejvs.2002.1630
[9]	D’Souza J, Halandras PM, Bechara CF. Aortocaval fistula: a rare complication of abdominal aortic aneurysm. Ann Vasc Surg. 2017; 38: 317. e1-317. e5. https://doi.org/10.1016/j.avsg.2016.08.016
[10]	Brewster DC. Clinical and pathophysiologic considerations in aortocaval fistulas. Semin Vasc Surg. 1995; 8(4): 321-8. https://doi.org/10.1016/S0895-7967(95)80023-9
[11]	Chaikof EL, Dalman RL, Eskandari MK, Jackson BM, Lee WA, Mansour MA, et al. SVS practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018; 67(1): 2-77. e2. https://doi.org/10.1016/j.jvs.2017.10.044
[12]	Lee WA, Nelson PR, Berceli SA, Seeger JM, Huber TS. Outcome after endovascular repair of abdominal aortic aneurysms with aortocaval fistula. J Vasc Surg. 2008; 48(1): 15-9. https://doi.org/10.1016/j.jvs.2008.02.059
[13]	Smith RB, Perdue GD, Hollier LH, Bernatz PE, Pairolero PC, Cherry KJ. Aortocaval fistula: a complication of abdominal aortic aneurysms. Surgery. 1981; 89(2): 243-9.
[14]	Greenberg RK, Clair D, Srivastava S, Bhandari G, Turc A, Hampton J, et al. Should patients with challenging anatomy be offered endovascular aneurysm repair? J Vasc Surg. 2004; 40(3): 435-44. https://doi.org/10.1016/j.jvs.2004.06.027
[15]	Sohail AH, Cohen K, Ho K, Cimaroli S, Brathwaite CEM, Shin P. Incidental aortocaval fistula in the setting of an unruptured abdominal aortic aneurysm. J Surg Case Rep. 2023; 2023(7): rjad384 https://doi.org/10.1093/jscr/rjad384
[16]	Gomes KEB, Sanvesso EK, Joviliano EE, Ribeiro MS, Zampieri EHS. Aortocaval fistula: a rare complication of ruptured abdominal aortic aneurysm. Arq Bras Cardiol: Imagem cardiovasc. 2023; 36(2): e369. https://doi.org/10.47593/2675-312X/20233602e369
[17]	Vaz Dias M, Patrão P, Cardoso D, Almeida A. Aortocaval fistula: a rare complication of abdominal aortic aneurysm. Eurorad. 2024; Case 18657. https://doi.org/10.26044/ecr202418657
[18]	Oderich GS, Panneton JM, Bower TC, Cherry KJ, Sullivan TM, Noel AA, et al. Endovascular repair of aortocaval fistula: a word of caution. J Vasc Surg. 2010; 51(2): 284-93. https://doi.org/10.1016/j.jvs.2009.08.075

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APA Style

Thiaw, A. A., Sow, N. F., Mbengue, A. L., Samba, M. M., Diagne, P. A., et al. (2026). Ruptured Infrarenal Abdominal Aortic Aneurysm with Aortocaval Fistula: Open Surgical Repair and Clinical Outcome. International Journal of Cardiovascular and Thoracic Surgery, 12(2), 70-74. https://doi.org/10.11648/j.ijcts.20261202.18

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ACS Style

Thiaw, A. A.; Sow, N. F.; Mbengue, A. L.; Samba, M. M.; Diagne, P. A., et al. Ruptured Infrarenal Abdominal Aortic Aneurysm with Aortocaval Fistula: Open Surgical Repair and Clinical Outcome. Int. J. Cardiovasc. Thorac. Surg. 2026, 12(2), 70-74. doi: 10.11648/j.ijcts.20261202.18

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AMA Style

Thiaw AA, Sow NF, Mbengue AL, Samba MM, Diagne PA, et al. Ruptured Infrarenal Abdominal Aortic Aneurysm with Aortocaval Fistula: Open Surgical Repair and Clinical Outcome. Int J Cardiovasc Thorac Surg. 2026;12(2):70-74. doi: 10.11648/j.ijcts.20261202.18

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@article{10.11648/j.ijcts.20261202.18,
  author = {Abdoul Aziz Thiaw and Ndeye Fatou Sow and Abdou Lahat Mbengue and Moussa Mareme Samba and Papa Amath Diagne and Momar Sokhna Diop and Dialtabe Ibrahima Ba and Mory Camara and Abdou Khoudouss Diallo and Mareme Soda Mbaye and Moussa Seck Diop and Anta Mbaye Sall and Cheikh Abdou Khadre Faye and Amadou Dioulde Diallo and Pape Ousmane Ba and Magaye Gaye and Souleymane Diatta and Papa Salmane Ba and Papa Adama Dieng and Amadou Gabriel Ciss},
  title = {Ruptured Infrarenal Abdominal Aortic Aneurysm with Aortocaval Fistula: Open Surgical Repair and Clinical Outcome},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {12},
  number = {2},
  pages = {70-74},
  doi = {10.11648/j.ijcts.20261202.18},
  url = {https://doi.org/10.11648/j.ijcts.20261202.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20261202.18},
  abstract = {Background: Aortocaval fistula (ACF) is a rare but life-threatening complication of abdominal aortic aneurysm (AAA), occurring in approximately 1% of all AAAs and up to 6% of ruptured cases. It results from progressive erosion of the aneurysmal wall into the inferior vena cava, creating a pathological arteriovenous communication that may lead to high-output cardiac failure, venous hypertension, and renal dysfunction. Because clinical manifestations are highly variable, diagnosis is often delayed. Computed tomography angiography remains the diagnostic modality of choice, allowing visualization of early venous opacification and characterization of aneurysm morphology. Case Presentation: We report the case of a 65-year-old woman presenting with acute abdominal pain and exertional dyspnea. CT angiography demonstrated a 68-mm infrarenal ruptured AAA with early opacification of the inferior vena cava, confirming an ACF. Despite the rupture, the patient remained hemodynamically stable, with preserved renal function and normal laboratory parameters. Management: Emergency open surgical repair was performed through a midline laparotomy. After proximal and distal vascular control, the aneurysm sac was opened, revealing a large fistulous defect on the right posterolateral aortic wall. The venous defect was closed with interrupted sutures, followed by an aortobi-iliac bypass using a bifurcated prosthetic graft. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 8. At 30-day follow-up, she remained asymptomatic, and Doppler ultrasound confirmed graft patency without residual arteriovenous communication. Conclusion: Aortocaval fistula remains an uncommon but severe complication of infrarenal AAA. Early recognition and prompt surgical intervention are essential to reduce morbidity and mortality. While endovascular repair is an emerging alternative in selected patients, open repair continues to be the standard approach in many settings, particularly where endovascular resources are limited or when the fistula is large or anatomically complex.},
 year = {2026}
}

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TY  - JOUR
T1  - Ruptured Infrarenal Abdominal Aortic Aneurysm with Aortocaval Fistula: Open Surgical Repair and Clinical Outcome
AU  - Abdoul Aziz Thiaw
AU  - Ndeye Fatou Sow
AU  - Abdou Lahat Mbengue
AU  - Moussa Mareme Samba
AU  - Papa Amath Diagne
AU  - Momar Sokhna Diop
AU  - Dialtabe Ibrahima Ba
AU  - Mory Camara
AU  - Abdou Khoudouss Diallo
AU  - Mareme Soda Mbaye
AU  - Moussa Seck Diop
AU  - Anta Mbaye Sall
AU  - Cheikh Abdou Khadre Faye
AU  - Amadou Dioulde Diallo
AU  - Pape Ousmane Ba
AU  - Magaye Gaye
AU  - Souleymane Diatta
AU  - Papa Salmane Ba
AU  - Papa Adama Dieng
AU  - Amadou Gabriel Ciss
Y1  - 2026/03/28
PY  - 2026
N1  - https://doi.org/10.11648/j.ijcts.20261202.18
DO  - 10.11648/j.ijcts.20261202.18
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 70
EP  - 74
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20261202.18
AB  - Background: Aortocaval fistula (ACF) is a rare but life-threatening complication of abdominal aortic aneurysm (AAA), occurring in approximately 1% of all AAAs and up to 6% of ruptured cases. It results from progressive erosion of the aneurysmal wall into the inferior vena cava, creating a pathological arteriovenous communication that may lead to high-output cardiac failure, venous hypertension, and renal dysfunction. Because clinical manifestations are highly variable, diagnosis is often delayed. Computed tomography angiography remains the diagnostic modality of choice, allowing visualization of early venous opacification and characterization of aneurysm morphology. Case Presentation: We report the case of a 65-year-old woman presenting with acute abdominal pain and exertional dyspnea. CT angiography demonstrated a 68-mm infrarenal ruptured AAA with early opacification of the inferior vena cava, confirming an ACF. Despite the rupture, the patient remained hemodynamically stable, with preserved renal function and normal laboratory parameters. Management: Emergency open surgical repair was performed through a midline laparotomy. After proximal and distal vascular control, the aneurysm sac was opened, revealing a large fistulous defect on the right posterolateral aortic wall. The venous defect was closed with interrupted sutures, followed by an aortobi-iliac bypass using a bifurcated prosthetic graft. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 8. At 30-day follow-up, she remained asymptomatic, and Doppler ultrasound confirmed graft patency without residual arteriovenous communication. Conclusion: Aortocaval fistula remains an uncommon but severe complication of infrarenal AAA. Early recognition and prompt surgical intervention are essential to reduce morbidity and mortality. While endovascular repair is an emerging alternative in selected patients, open repair continues to be the standard approach in many settings, particularly where endovascular resources are limited or when the fistula is large or anatomically complex.
VL  - 12
IS  - 2
ER  -

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Author Information

Abdoul Aziz Thiaw

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal

Contact Email

http://orcid.org/0009-0006-5360-9030
Ndeye Fatou Sow

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal

http://orcid.org/0009-0009-9001-6850
Abdou Lahat Mbengue

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal
Moussa Mareme Samba

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal

http://orcid.org/0009-0006-5198-3651
Papa Amath Diagne

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal

http://orcid.org/0009-0003-8853-9536
Momar Sokhna Diop

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal
Dialtabe Ibrahima Ba

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal
Mory Camara

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal
Abdou Khoudouss Diallo

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal
Mareme Soda Mbaye

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal
Moussa Seck Diop

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal
Anta Mbaye Sall

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal
Cheikh Abdou Khadre Faye

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal

http://orcid.org/0009-0002-2062-1202
Amadou Dioulde Diallo

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal
Pape Ousmane Ba

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal
Magaye Gaye

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal
Souleymane Diatta

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal
Papa Salmane Ba

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal
Papa Adama Dieng

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal
Amadou Gabriel Ciss

Thoracic and Cardiovascular Surgery Department, National University Hospital Center of Fann, Dakar, Senegal

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Table 1

Table 1. Comparison of our case with the main series and case reports published on aortocaval fistulas.

Plain Text BibTeX RIS

APA Style

Thiaw, A. A., Sow, N. F., Mbengue, A. L., Samba, M. M., Diagne, P. A., et al. (2026). Ruptured Infrarenal Abdominal Aortic Aneurysm with Aortocaval Fistula: Open Surgical Repair and Clinical Outcome. International Journal of Cardiovascular and Thoracic Surgery, 12(2), 70-74. https://doi.org/10.11648/j.ijcts.20261202.18

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ACS Style

Thiaw, A. A.; Sow, N. F.; Mbengue, A. L.; Samba, M. M.; Diagne, P. A., et al. Ruptured Infrarenal Abdominal Aortic Aneurysm with Aortocaval Fistula: Open Surgical Repair and Clinical Outcome. Int. J. Cardiovasc. Thorac. Surg. 2026, 12(2), 70-74. doi: 10.11648/j.ijcts.20261202.18

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Thiaw AA, Sow NF, Mbengue AL, Samba MM, Diagne PA, et al. Ruptured Infrarenal Abdominal Aortic Aneurysm with Aortocaval Fistula: Open Surgical Repair and Clinical Outcome. Int J Cardiovasc Thorac Surg. 2026;12(2):70-74. doi: 10.11648/j.ijcts.20261202.18

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@article{10.11648/j.ijcts.20261202.18,
  author = {Abdoul Aziz Thiaw and Ndeye Fatou Sow and Abdou Lahat Mbengue and Moussa Mareme Samba and Papa Amath Diagne and Momar Sokhna Diop and Dialtabe Ibrahima Ba and Mory Camara and Abdou Khoudouss Diallo and Mareme Soda Mbaye and Moussa Seck Diop and Anta Mbaye Sall and Cheikh Abdou Khadre Faye and Amadou Dioulde Diallo and Pape Ousmane Ba and Magaye Gaye and Souleymane Diatta and Papa Salmane Ba and Papa Adama Dieng and Amadou Gabriel Ciss},
  title = {Ruptured Infrarenal Abdominal Aortic Aneurysm with Aortocaval Fistula: Open Surgical Repair and Clinical Outcome},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {12},
  number = {2},
  pages = {70-74},
  doi = {10.11648/j.ijcts.20261202.18},
  url = {https://doi.org/10.11648/j.ijcts.20261202.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20261202.18},
  abstract = {Background: Aortocaval fistula (ACF) is a rare but life-threatening complication of abdominal aortic aneurysm (AAA), occurring in approximately 1% of all AAAs and up to 6% of ruptured cases. It results from progressive erosion of the aneurysmal wall into the inferior vena cava, creating a pathological arteriovenous communication that may lead to high-output cardiac failure, venous hypertension, and renal dysfunction. Because clinical manifestations are highly variable, diagnosis is often delayed. Computed tomography angiography remains the diagnostic modality of choice, allowing visualization of early venous opacification and characterization of aneurysm morphology. Case Presentation: We report the case of a 65-year-old woman presenting with acute abdominal pain and exertional dyspnea. CT angiography demonstrated a 68-mm infrarenal ruptured AAA with early opacification of the inferior vena cava, confirming an ACF. Despite the rupture, the patient remained hemodynamically stable, with preserved renal function and normal laboratory parameters. Management: Emergency open surgical repair was performed through a midline laparotomy. After proximal and distal vascular control, the aneurysm sac was opened, revealing a large fistulous defect on the right posterolateral aortic wall. The venous defect was closed with interrupted sutures, followed by an aortobi-iliac bypass using a bifurcated prosthetic graft. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 8. At 30-day follow-up, she remained asymptomatic, and Doppler ultrasound confirmed graft patency without residual arteriovenous communication. Conclusion: Aortocaval fistula remains an uncommon but severe complication of infrarenal AAA. Early recognition and prompt surgical intervention are essential to reduce morbidity and mortality. While endovascular repair is an emerging alternative in selected patients, open repair continues to be the standard approach in many settings, particularly where endovascular resources are limited or when the fistula is large or anatomically complex.},
 year = {2026}
}

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TY  - JOUR
T1  - Ruptured Infrarenal Abdominal Aortic Aneurysm with Aortocaval Fistula: Open Surgical Repair and Clinical Outcome
AU  - Abdoul Aziz Thiaw
AU  - Ndeye Fatou Sow
AU  - Abdou Lahat Mbengue
AU  - Moussa Mareme Samba
AU  - Papa Amath Diagne
AU  - Momar Sokhna Diop
AU  - Dialtabe Ibrahima Ba
AU  - Mory Camara
AU  - Abdou Khoudouss Diallo
AU  - Mareme Soda Mbaye
AU  - Moussa Seck Diop
AU  - Anta Mbaye Sall
AU  - Cheikh Abdou Khadre Faye
AU  - Amadou Dioulde Diallo
AU  - Pape Ousmane Ba
AU  - Magaye Gaye
AU  - Souleymane Diatta
AU  - Papa Salmane Ba
AU  - Papa Adama Dieng
AU  - Amadou Gabriel Ciss
Y1  - 2026/03/28
PY  - 2026
N1  - https://doi.org/10.11648/j.ijcts.20261202.18
DO  - 10.11648/j.ijcts.20261202.18
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 70
EP  - 74
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20261202.18
AB  - Background: Aortocaval fistula (ACF) is a rare but life-threatening complication of abdominal aortic aneurysm (AAA), occurring in approximately 1% of all AAAs and up to 6% of ruptured cases. It results from progressive erosion of the aneurysmal wall into the inferior vena cava, creating a pathological arteriovenous communication that may lead to high-output cardiac failure, venous hypertension, and renal dysfunction. Because clinical manifestations are highly variable, diagnosis is often delayed. Computed tomography angiography remains the diagnostic modality of choice, allowing visualization of early venous opacification and characterization of aneurysm morphology. Case Presentation: We report the case of a 65-year-old woman presenting with acute abdominal pain and exertional dyspnea. CT angiography demonstrated a 68-mm infrarenal ruptured AAA with early opacification of the inferior vena cava, confirming an ACF. Despite the rupture, the patient remained hemodynamically stable, with preserved renal function and normal laboratory parameters. Management: Emergency open surgical repair was performed through a midline laparotomy. After proximal and distal vascular control, the aneurysm sac was opened, revealing a large fistulous defect on the right posterolateral aortic wall. The venous defect was closed with interrupted sutures, followed by an aortobi-iliac bypass using a bifurcated prosthetic graft. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 8. At 30-day follow-up, she remained asymptomatic, and Doppler ultrasound confirmed graft patency without residual arteriovenous communication. Conclusion: Aortocaval fistula remains an uncommon but severe complication of infrarenal AAA. Early recognition and prompt surgical intervention are essential to reduce morbidity and mortality. While endovascular repair is an emerging alternative in selected patients, open repair continues to be the standard approach in many settings, particularly where endovascular resources are limited or when the fistula is large or anatomically complex.
VL  - 12
IS  - 2
ER  -

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