Abdominal aortic aneurysm with rupture into the inferior vena cava/Vena kava inferiyor'a rupture olan abdominal aort anevrizmas.

A 65-year-old man referred to our institute with an emergent situation. Physical examination revealed sinus tachycardia (130 beats/min), hypotension (90/35 mmHg), large pulsatile mass in abdomen, hemoglobin: 10.1 gr/dl. We considered abdominal aneurysm rupture and performed computerized tomography scanning. It showed juxta-renal abdominal aortic aneurysm (AAA) and long segment aorto-caval fistula (Fig. 1). The patient emergently was taken to operating room. Firstly, we opened abdomen and revealed big AAA (more than 10 cm), then we prepared aneurysm but we could not take it on cross-clamp inside abdomen. The incision was extended to thoracic level (9. cartilage) and we took on cross-clamp above diaphragm. When we opened aneurysm sac, suddenly and rapidly bleeding occurred,we controlled caval bleeding with balloon catheter and performed proximal aortic anastomosis with 18/9 aorta-iliac graft on renal arteries (Jotec Inc. Minnesota, USA). We took off aortic cross clamp and repaired caval injury with 2x8 cm. Dacron patch. Aorto-caval fistula is very rare complication of AAA and this pathology can be repaired with endovascular graft replacement. In this case, caval injury was in a long segment and we had to use Dacron patch for inferior vena cava. We used expandable balloon catheter for cessation of bleeding in this case. It was very useful and life saving procedure and we repaired tear of inferior vena cava without bleeding complications easily (Fig. 2).

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Mehmet Ates, Ufuk Ciloglu, Ahmet Umit Gullu, Sabri Dagsali, Ibrahim Yekeler

Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey

Address for Correspondence/Yazisma Adresi: Dr. Mehmet Ates Sairarsi Cad. Emincinarpasa Sok. No: 6/24 Kadikoy 34732, Istanbul, Turkey Phone: [phone] E-mail: [e-mail]