Aneurysms of the abdominal aorta. Fissures in the vena cava. Apropos of 4 cases

Four cases of aortico-caval fistulae of atheromatous origin have been treated over a period of 5 years, a frequency (4.8%) much higher than that reported in the international literature. Diagnosis in each of these 4 cases was suggested by clinical features associating signs of a complicated aneurysm with those of a high-output arteriovenous fistula, angiography showing the arteriovenous communication in one patient only. Treatment of choice is by graft to aneurysm sac and suturing of fistula by an endosaccular approach. Prognosis is much more favorable (mortality 25%) than that of rupture into the free peritoneum (mortality 77,4%).