Aortoiliac aneurysm with arteriocaval fistula treated by a bifurcated endovascular stent-graft

Abstract

A 71-year-old patient with high-output cardiac failure was found to have an aneurysmal distal aorta with evidence of an arteriocaval fistula on ultrasound scanning. CT demonstrated an aneurysm of the distal aorta and right common iliac artery and an intraarterial digital subtraction angiogram confirmed an arteriocaval fistula. In view of the patient's cardiac failure and general condition an endovascular stent was considered. The right internal iliac artery was occluded with Tungsten coils prior to the insertion of a bifurcated stent-graft. This resulted in total occlusion of the aneurysm and obliteration of the arteriocaval fistula. To our knowledge such a case has not been previously reported.

Delayed Endovascular Aneurysm Repair for Aorto-caval Fistula with Correction of Physiologic and Metabolic Abnormalities: A Disease Process Review

“…This presentation accounts for 2e4% of acute AAA rupture. 1 In this circumstance, the physiologic consequence is that of venous hypertension that can lead to various clinical sequelae. One of these is increased venous return to the heart with fluid overload and high output cardiac failure.…”

“…Aorto-caval fistula (ACF) is a rare presentation of ruptured AAA occurring in 2e4% of acute AAA rupture. 1 The physiologic changes associated with ACF differ from isolated hypotension and shock associated with typical AAA rupture. Rapid diagnosis and treatment offer the best chance of survival.…”

Peritonitis as Presentation of Aorto-Caval Fistula with Salmonella choleraesuis-Associated Abdominal Aortic Aneurysm

“…This is a common problem with such lesions. Endovascular repair of an aorto-caval fistula has been a therapeutic option since 1998 [4]. However, the only case series describing endovascular treatment of aorto-caval fistulae showed a complicated clinical picture, with a mortality rate of 75% [5].…”

Aortocaval Fistula: Is Endovascular Repair the Preferred Solution?

“…At the dawn of the endovascular age, most ACF had been repaired primarily in an open fashion and the literature accounted the surgical mortality to be as high as 16–66%. 4,5 However, after Beveridge et al 6 in 1998 reported the first endovascular repair of ACF, many have published reports of ACF describe endovascular management. We sought to review the contemporary outcomes and complications of both methods, present a successful case of open repair, and determine if endovascular repair was associated with improved outcomes.…”