Fistulous communications between the abdominal aorta (or its common iliac branches) and the inferior vena cava (IVC) have long been recognized, with the first report being attributed to &me1 in 1831; however, these central arteriovenous fistulas are not common. This report describes a case of arteriovenous fistula between the right common iliac artery (RCIA) and the IVC in which the major feature on ultrasound examination was a grossly dilated IVC.
CASE REPORT
A 69-yr-old woman was admitted to the Royal Perth Hospital, complaining of swelling of both legs and the abdomen of six weeks' duration.
On examination, she showed signs of right heart failure, and some left heart failure as well. Ascites with a pulsatile liver was noted, together with bilateral leg edema and basal crepitation. A chest radiograph showed cardiomegaly with congested lungs and pleural effusions. The findings at cardiac catheterization were severe tricuspid incompetence, pulmonary hypertension, left ventricular impairment, mild aortic regurgitation, and a left-to-right shunt at a low atrial level. At operation, no atrial septa1 defect (ASD) was found, but annuloplasty was performed for functional tricuspid incompetence. It was noted that there was highly oxygenated blood in the IVC compared with the superior vena cava (SVC) (deoxygenated). No anomalous venous drainage to the IVC through the diaphragm was found, but the abdomen was not opened due t o the presence of gross ascites.