Ruptured abdominal aortic aneurysm, aorto-caval fistula and inferior vena cava thrombosis: Temporary caval filter utility in the management of this inusual association

Ruptured abdominal aortic aneurysm (AAA) associated with an aortocaval fistula and inferior vena cava thrombosis is a rare entity with a high mortality rate: to date only a few cases has been reported in the world literature. The case we present, diagnosed by means of a spiral-CT scan, has been successfully treated by open surgical repair after positioning of a temporary vena cava filter above the renal veins. The aortocaval fistula was sutured from within the aneurysmal sac. The filter was removed at postoperative day 11th after a control CT scan. The preoperative acute renal insufficiency recovered promptly after surgical repair. The postoperative course was uneventful. The patient had no history suggestive for pulmonary embolism and a chest X-ray didn't show any sign of pulmonary disventilation. This combinations of pathologic events, besides to have important diagnostic difficulties, shows some tactical and technical operative problems not easy to be solved.