Aortocaval fistula (ACF) repair is a complex and intricate surgical procedure aimed at correcting an abnormal
connection between the aorta and the inferior vena cava (IVC). This condition, although rare, is often associated with
significant morbidity and mortality if not treated promptly and effectively.
The aorta, being the largest artery in the body, carries oxygenated blood from the heart to various organs, while the
IVC is a large vein that returns deoxygenated blood from the lower body to the heart. An ACF creates a direct
communication between these two vessels, leading to a host of complications. Patients with an ACF may present
with symptoms such as a pulsatile abdominal mass, lower back pain, venous hypertension, and heart failure.
Aortocaval fistula repair is a life-saving intervention that requires meticulous planning, surgical expertise, and
comprehensive postoperative care. The primary goal of ACF repair is to disconnect the abnormal fistulous
communication and restore normal blood flow in the aorta and IVC. This is typically achieved through open surgery,
which involves a large abdominal incision to access the affected vessels. In some cases, endovascular techniques,
which involve less invasive methods using catheters and stents, may be employed. During the procedure, surgeons
carefully isolate and control the aorta and IVC. The fistula is then identified, and the connection between the aorta
and IVC is closed. This often involves suturing the openings in the vessels or applying patches to reinforce the
vessel walls. In cases where the aorta or IVC is severely damaged, grafts may be used to replace the affected
sections.
Postoperative care is critical for the success of ACF repair. Patients are closely monitored for signs of bleeding,
infection, and organ function. Recovery can be lengthy, and patients may require blood transfusions, pain
management, and physical therapy. Advances in surgical techniques and imaging technologies have improved the
outcomes of ACF repair. However, the procedure remains challenging due to the complexity of the anatomy and the
potential for significant blood loss and other complications.