[Angina pectoris as initial clinical manifestation of ruptured abdominal aortic aneurysm with aortocaval fistula].

Case Report: A 75-year-old patient was hospitalized for angina pectoris and tachycardia. Neither ECG nor laboratory examinations were diagnostic for myocardial infarction. Because of an abdominal thrill and a history of an aortic aneurysm a thoracic and abdominal CT scan was performed. It revealed a rupture of the infrarenal aortic aneurysm into the inferior vena cava. In an emergency operation the aortocaval fistula was closed and the infrarenal aorta including both Aa. iliacae was replaced by a prosthesis. The patient recovered rapidly and was discharged home on the 11th postoperative day.

Conclusion: Aortocaval fistulas are rare complications of abdominal aortic aneurysms. Due to altered hemodynamics they may become manifest by symptoms usually typical for other diseases. Computed tomography appears to be the most rapid and safe diagnostic measure. Particularly in patients with unstable hemodynamics, surgical transaneurysmatic closure of the fistula together with a prosthetic replacement of the diseased vessel is the therapy of choice.