A Successfully Treated Case of Abdominal Aortic and Iliac Aneurysms Associated with Iliac Arteriovenous Fistula.

Abstract

A 72-year-old man suffering from congestive heart failure, swelling of the lower limbs and hematuria was transferred from another hospital with a diagnosis of large aneurysms of the abdominal aorta and the left common iliac artery.Iliac arteriovenous fistula (AVF) was definitively diagnosed preoperatively by contrast-enhanced CT and angiogaphy. At operation, an infrarenal abdominal aortic aneurysm of 8 cm and left iliac arterial aneurysm of 12 cm were identified. After proximal and distal aortic clamping, the aneurysm was entered and an AVF orifice of 1 cm communicating with the left common iliac vein was disclosed at the right posterior wall of the left common iliac artery. Venous blood reflux was controlled by inserting an occlusive balloon catheter to the fistula and intraoperative shed blood was aspirated and returned by an autotransfusion system. The AVF was closed from inside the iliac aneurysm by three interrupted 3-0 monofilament mattress sutures with pledgets. The aneurysms were resected and replaced with a bifurcated Dacron prosthetic graft. The patient had an uncomplicated postoperative recovery ; the lower limb edema subsided and heart failure improved rapidly. Preoperative identification of the location of the AVF is mandatory to make surgery safe. Moreover, easy availability or routine use of the devices for controlling undue blood loss such as an autotransfusion system and an occlusive balloon catheter are other important supplementary means to obtain good results of surgical treatment.

Successful Repair of a Ruptured Common Iliac Aneurysm with Associated Arteriovenous Fistula Using Aneurysm Wall

“…Ruptured abdominal aortic aneurysms and CIAAs rarely develop into AVFs, occurring in only 6% of ruptured aortic aneurysms. 2) Ruptured CIAAs with associated AVFs often cannot be detected promptly; delayed diagnosis of a ruptured CIAA occurs in 60% of the cases, 3) resulting in poor prognosis. Symptoms vary depending on the shape and size of the aneurysm and include palpable pulsatile masses, as well as high-output heart failure, deep venous thrombosis, lymphorrhea, and venous hypertension, which are common symptoms of an AVF in ruptured aneurysms.…”

“…Large amounts of bleeding are expected when an aneurysm with an AVF is incised. For small AVFs, methods such as using a Fogarty occlusion catheter, compressing the iliac veins, and using balloon-tipped catheters to control bleeding from AVFs have been reported 3,5,6) ; however, for large AVFs, it is difficult to control bleeding. Extracting the patient's blood and returning it to the patient via autologous blood transfusion may be necessary.…”