Death in patients with arteriosclerotic aneurysms of the abdominal aorta usually follows rupture of the aneurysm. While the majority of aneurysms rupture into the retroperitoneal space, a few rupture into the free peritoneal cavity, and fewer still rupture into the gastrointestinal tract. On rare occasions, arteriosclerotic aneurysms of the abdominal aorta rupture into the inferior vena cava, producing an arteriovenous fistula of unusual magnitude resulting in serious circulatory and cardiac consequences.
This rare complication of abdominal aortic aneurysms was first reported by Syme in 1831 and was illustrated by drawings as early as 1850 in Rokitanski's Book of Patho-logical Anatomy (Boffi1). Matas,2 in 1909, referred to a report of 20 cases by Boinet of spontaneous abdominal aortocaval fistula. Boffi1 reviewed the world literature up to 1955 and documented 26 cases of abdominal aortic aneurysms opening spontaneously into the inferior vena cava. Among these collected cases not