Background
The rupture of an abdominal aortic aneurysm(AAA) into the inferior vena cava with fistula formation is a rare condition, but is associated with high mortality.
Case
An 88 years-old man with medical history of hypertension and coronary artery disease, presented to the Emergency Department (ER) with a history of having low blood pressure readings and abdominal pain for the last six days. His daughter indicated that they did not seek medical care early because they were afraid of contracting COVID-19 at the medical facility. Physical examination revealed tachycardia, hypotension, and a large pulsatile mass in the abdomen. A contrasted computed tomography demonstrated an 11.3 cm inferior AAA with layering in the right common iliac artery aneurysm concerning for acute rupture into the inferior vena cava.
Decision-making
The patient was taken to the operating room emergently for repair of a ruptured AAA. Unfortunately, the patient had a cardiac arrest and passed away.
Conclusion
Most aorto-caval fistulas occur spontaneously and are the result of the rupture of existing AAA. The dire clinical outcome of this patient might have been prevented if he had sought timely medical help. Continues reinforcement of the importance of routine monitoring and about alarm sign is needed to avoid adverse outcomes.
Footnotes
Poster Contributions
Monday, May 17, 2021, 10:45 a.m.-11:30 a.m.
Session Title: Complex Clinical Cases: FIT Vascular Medicine 3
Abstract Category: FIT: Vascular Medicine