THE SUDDEN rupture of an aortic aneurysm remains one of the most striking and urgent problems encountered in medicine. Free rupture, or rupture into another organ, may present a wide variety of symptoms, but common to most is evidence of blood loss. The subject of this report is observations on a patient with acute rupture of an abdominal aortic aneurysm into the inferior vena cava and retroperitoneal space.
Reports of successful repairs of aortic-vena caval fistula from ruptured arteriosclerotic aneurysms have been appearing over the past 12 years.1-3 The first successful repair of this lesion was reported by Cooley in 1955.4 The Baylor group5 in 1962 reported 1,400 patients treated for abdominal aortic aneurysms in a ten-year period. Of this group, 130 had ruptured and four of these had ruptured into the inferior vena cava. With development of this fistula, a rather typical pattern appears. In the