Anaesthetic Management in Surgical Repair of Aortocaval Fistula: A Case Report

Aortocaval fistula (ACF), a rare complication of aortic aneurysms, poses critical haemodynamic challenges during surgical repair.The authors present a 67-year-old male with decompensated heart failure due to a right iliac artery aneurysm compressing the inferior vena cava, complicated by a high-flow ACF (diameter 0.7 cm).Preoperative findings included respiratory failure, extreme brain natriuretic peptide elevation, hepatic congestion, and ascites.Emergency surgery under general anaesthesia was necessitated by worsening orthopnoea and agitation.Intraoperatively, balloon occlusion of the femoral artery triggered refractory hypotension with paradoxically elevated central venous pressure, unresponsive to vasopressors.Immediate fistula closure, combined with fluid restriction and glucocorticoids, restored haemodynamic stability.Finally, we performed the endovascular repair of the ACF successfully.The accurate preoperative diagnosis, precise anaesthesia management, and successful surgical repair of the ACF are the keys to a good prognosis for the patient.