To the Editor.—
As we share a particular interest in major spontaneous intra-abdominal fistulas, we enjoyed Dr Richards' case report and would like to offer our views.Since 1975, we have seen five major fistulas among 370 atherosclerotic abdominal aneurysms. Two were ileoiliac, as described by Dr Richards. Briefly, four patients underwent surgery with end-aneurysmal closure of the fistula and graft replacement of the aneurysm. Three patients had Swan-Ganz monitoring and survived. A review of 78 such cases reported in the past 30 years revealed the following: 89% survived with Swan-Ganz monitoring v 68% without, and 84% survived with end-aneurysmal closure v 52% with other surgical approaches. Although these observations reflect refinements in management over the years and no doubt involve many factors, the trend toward Swan-Ganz catheter monitoring and end-aneurysmorrhaphy seems to be critical.Dr Richards failed to give proper credit to Zajtchuk et al,1 whose diagram clearly
Astarita DC, Fares LG, Glass R. Spontaneous Fistula Between a Right Common Iliac Artery and Iliac Vein. JAMA. 1984;252(13):1684–1685. doi:10.1001/jama.1984.03350130016021
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