Peculiar patterns of aortic pathology: diagnosis and best treatment

Aortovenous fistulae are rare in clinical practice with different etiologies. Although very rare in general, traumatic genesis is most frequent. Gunshot and stab wounds are most common, as well as iatrogenic injuries, associated with surgical procedures (i.e., spinal cord surgery). In addition, aortovenous fistulae may occur spontaneously, due to aortic plaque erosion or rupture of an aortic aneurysm. Most often, such erosions occur near aortoiliacal bifurcation, resulting in aortocaval fistulae. Less common, these fistula may affect iliac veins, the left renal vein, or mesenteric veins. Such a fistula may be congenital in very rare cases. Most patients complain of abdominal pain, and back pain may also be present. Depending on the size of the fistula, symptoms of high cardiac output failure, dyspnea, and even lower extremity edema may be present. Spontaneous and traumatic fistulae may increase in size and volume over many years, which may obscure the diagnosis. Abdominal aortic aneurysm rupture into the inferior cava vein may cause a very sudden onset of cardiac decompensation, which may challenge the underlying diagnosis.