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October 1964

Abdominal Aortic Aneurysm With Vena Caval FistulaReport of a Case With Observations on an Unusual Clinical Course

Arch Intern Med. 1964;114(4):551-554. doi:10.1001/archinte.1964.03860100133018

By the fourth decade of life, when the intima of the aorta achieves histologic maturity, degenerative processes in the large arteries are already gaining momentum. These occur more in the aorta than in its smaller more muscular branches. The most significant change is a disruption of the elastica and to a lesser degree the muscular elements. There is subsequent displacement by less resistant collagen tissue and infiltration with calcific and atherosclerotic elements. This may result in aneurysmal dilatation and even rupture.1

The increasing incidence of arteriosclerotic aortic aneurysm warrants a review of its diagnostic features and complications. Over 50% of such aneurysms will eventually rupture,1 usually into the retroperitoneal space. Occasionally the aneurysm may rupture into the gastrointestinal lumen, most frequently the adjacent third portion of the duodenum.2 Less often, the aneurysm may erode into the adjacent inferior vena cava and form an arteriovenous fistula.3-6 Preoperative

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