Aortocaval fistulae are rare entities with a variety of etiologies and are very often associated with significant morbidity and mortality. It is believed that increased tension in the walls of large aneurysms can cause an inflammatory reaction resulting in adhesion to the adjacent vein and culminating in erosion of the adherent layers and fistula formation. Conventional surgical treatment has high mortality rates. Paradoxical pulmonary embolism and endoleaks are the most concerning complications linked with endovascular treatment. Using a vascular occluder in combination with a bifurcated endograft is a good option for the treatment of an abdominal aortic aneurysm with aortocaval fistula.Keywords: aneurysm aortic, aortocaval fistula, endovascular procedures.
ResumoAs fístulas aorto-cava são entidades raras e de etiologia variada, estando frequentemente associadas a significativa morbimortalidade. Acredita-se que o aumento da tensão da parede nos grandes aneurismas resulte em reação inflamatória e aderência à veia adjacente, culminando na erosão das camadas aderidas e na formação da fístula. O tratamento cirúrgico convencional tem altas taxas de mortalidade. Embolia pulmonar paradoxal e o vazamento são complicações temidas do tratamento endovascular. O uso de oclusor vascular associado a endoprótese bifurcada é boa opção no tratamento do aneurisma de aorta abdominal com fístula aorto-cava.Palavras-chave: aneurisma aórtico; fístula aorto-cava; procedimentos endovasculares.
Whenever a patient who has undergone endovascular repair of an abdominal aortic aneurysm (EVAR) presents with sudden onset abdominal pains or signs of shock, the hypothesis of endoleak with aneurysm expansion and rupture should be considered. We present the case of an EVAR patient in whom a tumor of the duodenum mimicked an endoleak during the postoperative period.Keywords: angiosarcoma; endoleak; anerysm.
ResumoEm todo paciente submetido a reparo endovascular do aneurisma de aorta abdominal (REVA) que se apresente subitamente com quadro de dor abdominal ou sinais de choque, a hipótese de endoleak ou vazamento, com expansão do aneurisma e ruptura deve ser aventada. Apresentamos o caso de um paciente em pós-operatório de REVA que apresentou uma neoplasia de duodeno mimetizando um endoleak.Palavras-chave: angiossarcoma; endoleak; aneurisma.
Background: Endovascular repair has become established as a safe and effective method for treatment of abdominal aortic aneurysms. One major complication of this treatment is leakage, or endoleaks, of which type 2 leaks are the most common. Objective: To conduct a brief review of the literature and evaluate the safety and effectiveness of embolization by micronavigation for treatment of type 2 endoleaks. Method: A review of medical records from patients who underwent endovascular repair of abdominal aortic aneurysms identified 5 patients with persistent type 2 endoleaks. These patients were submitted to embolization by micronavigation. Results: In all cases, angiographic success was achieved and control CT scans showed absence of type 2 leaks and aneurysm sacs that had reduced in size after the procedure. Conclusion: Treatment of type 2 endoleaks using embolization by micronavigation is an effective and safe method and should be considered as a treatment option for this complication after endovascular repair of abdominal aortic aneurysms.
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