The advent of incretin mimetics such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has enriched the armamentarium for diabetes management owing to their glycaemic as well as extra-glycaemic benefits. The approval status and availability of this class of drugs vary widely across the globe. Being a relatively newer class of drug with numerous benefits, several national and international guidelines are working towards addressing clinical questions pertaining to the optimal use of GLP-1 RAs for the management of diabetes. Although the newer class of drugs are associated with significant benefits such as patient-centric approach, these drugs demand the providers to be vigilant and knowledgeable about the medication. The South Asian population is at higher risk of type 2 diabetes mellitus (T2DM) because of their genetic predisposition and lifestyle changes. Hence, prevention and management of T2DM and its associated complications in this population are of paramount importance. The current report aims to present an overview of Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.8850866.
Introduction
Aortocaval fistulas (ACFs) are a rare complication of abdominal aortic aneurysm (AAA), associated with high morbidity and mortality. It is thought that increased tension in the walls of large aneurysms can cause an inflammatory reaction resulting in adhesion to the adjacent vein and culminating in necrosis of the adherent layers and fistula formation.
Presentation of case
A 70-year-old male was referred from a local state center to the emergency department of our hospital, complaining of weakness and oliguria for two days. The laboratory analysis yielded high urea and creatinine levels, indicating an acute renal failure. Computed tomography images showed an aortocaval fistula complicating infrarenal abdominal aortic aneurysm. The patient was successfully managed with endovascular intervention.
Discussion
Aortocaval fistulas generally affect elderly men with an average age of 65 years. The diagnosis is often delayed because of the variable clinical manifestations, which increases the difficulties in treatment. Conventional surgical intervention has high mortality rates. However, endoleaks and paradoxical pulmonary embolism are the main concerning complications of endovascular treatment.
Conclusion
Spontaneous aortocaval fistulas are a rare, but potentially life-threatening complication of abdominal aortic aneurysm with myriad clinical manifestations. Early diagnosis and management can directly affect the prognosis and outcome. Modern non-invasive diagnostic imaging can help timely diagnosis and provide a road map for the treatment plan. Endovascular repair is the first choice of treatment. However, a high incidence and persistence of endoleak with the endovascular approach requires caution and a close long time follow up.
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