Abdominal aortic aneurysms ruptured to the vena cava: a case series and literature review

Background Arterio-venous fistula is a rare clinical entity that occurs as a result of a ruptured abdominal aortic aneurysm into the inferior vena cava or iliac vein. Open surgery has been considered the treatment of choice for this condition; however, endovascular repair has become an evolving therapeutic option over the past 20 years. The endovascular treatment has contributed to a decrease in the perioperative mortality; nevertheless, some endovascular repair specific concern for residual fistula still remains. Case presentation A 70-year-old man was referred to our department for an enlarged inferior vena cava without any complaint. Contrast-enhanced computed tomography demonstrated a 40-mm AAA and a 42-mm right saccular CIAA, with a fistula between the CIAA and left CIV. Endovascular aneurysm repair which focused on the exclusion of the right CIAA and prevention of endoleak formation was performed. To prevent type 2 endoleaks, which cause residual arterio-venous shunt flow, right internal iliac artery was embolized with a vascular plug prior to stent graft procedure. Successful aneurysm exclusion without residual arterio-venous shunt flow was confirmed with a final angiographic examination. The patient had an uneventful recovery, and computed tomography 1 month later showed no sign of persistent fistula. Conclusions Although endovascular treatment for AVF has a negative possibility of residual shunt, stent graft with a focus on type 2 endoleak prevention can be an attractive treatment option, reducing the incidence of residual AVF.

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A Rare Case of Ruptured Abdominal Aortic Aneurysm with the Formation of a Thrombosed Aortocaval Fistula, Thrombosis of the Inferior Vena Cava and Iliac Veins

Vishnyakova

Ларьков

Kolesnikov

et al. 2022

Neotložnaâ med. pomoŝʹ

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This article considers a rare case of rupture of abdominal aortic aneurysm with thrombosed aorto-caval fistula formation, with thrombosis of the inferior vena cava and iliac veins. During the multiphase computed tomography, early enhancement of inferior vena cava was not obtained, but non-contrasting aorto-caval fistula was revealed in the venous contrast phase, as well as the absence of the contrast in the adjacent parts of the inferior vena cava and iliac veins. The patient was successfully operated and the diagnosis was confirmed intraoperatively.

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Abdominal aortic aneurysms ruptured to the vena cava: a case series and literature review

Cited by 3 publications

References 12 publications

Treatment of Aortocaval Fistula Secondary to Abdominal Aortic Aneurysm: A Systematic Review

Treatment of Aortocaval Fistula Secondary to Abdominal Aortic Aneurysm: A Systematic Review

Endovascular repair for arterio-venous fistula treatment: a case report

A Rare Case of Ruptured Abdominal Aortic Aneurysm with the Formation of a Thrombosed Aortocaval Fistula, Thrombosis of the Inferior Vena Cava and Iliac Veins

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