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Emerg Med J. 2007 August; 24(8): 597.
PMCID: PMC2660101

Venous gangrene secondary to an aorto‐caval fistula

We report the unusual case of a 60‐year‐old‐man presenting with left lower limb venous gangrene caused by an aorto‐caval fistula. There was associated bilateral lower limb and scrotal oedema. In this case a ruptured aortic aneurysm with acute fistulation into the vena cava (fig 11)) was repaired in the conventional manner. However, the patient underwent above‐knee amputation of irreversible venous gangrene.

figure em39487.f1
Figure 1 Ruptured aortic aneurysm with acute fistulation into the vena cava.

Venous gangrene is typically caused by ilio‐femoral thrombosis, whereas aorto‐caval fistulation is a rare occurrence with only 250 cases reported. The diagnosis of an aorto‐caval fistula can be missed if meticulous examination of the abdomen is not done, especially for a pulsatile mass and a bruit which is associated with an aorto‐caval fistula. We hope this case will help our colleagues to consider this diagnosis when a case of venous gangrene is encountered.


Competing interests: None declared.

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