Fistula between the abdominal aorta and a retroaortic left renal vein: a rare complication of abdominal aortic aneurysm

Endovascular repair of a ruptured abdominal aortic aneurysm after endovascular aneurysm repair due type IB endoleak associated with a late fistula between the abdominal aorta and a retroaortic left renal vein

“… 1 In this case, the patient had a large aneurysm diameter (>7 cm), with a common iliac type IB endoleak, leading to aneurysmal sac pressurization and rupture . ALRVAF is a rare complication of AAA, first reported by Lord et al in 1964 5 and since then, around 30 other cases of ALRVAF have been described, 6 usually involving an anomalous RLRV. 7 However, only one report described a late complication of EVAR with an arteriovenous fistula between the aneurysm sac and a RLRV after a type III endoleak with AAA expansion.…”

“…It has been postulated that the perianeurysmal inflammation and venous wall compression-related necrosis between the pulsating aneurysm and the vertebral bodies, leading to vessel wall erosion and fistula formation. 6 , 7 , 8 , 11 …”

“…The presence of priapism among some patients with acute aortocaval fistula has also been described. 11 , 12 , 13 An ALRVAF may present with hematuria, renal impairment, abdominal, groin or left flank pain, 6 owing to the effect of venous hypertension in the left kidney. The clinical triad of pulsatile abdominal mass, hematuria, and continuous abdominal bruit is most suggestive of either ALRVAF or aortocaval fistula.…”

“…This minimizes blood loss in comparison with open surgery. 6 , 8 Upon device deployment and fistula exclusion, an immediate decrease in preload occurs, with concomitant reduction in renal vein congestion. 14 …”

“…The successful endovascular treatment of aortocaval fistulas or AAA rupture after EVAR has been reported, but around only 30 cases ALRVAF were found in the literature, 6 and only one after EVAR. 3 Ferrari et al described an ALRVAF after sac expansion owing to a disconnection between the right iliac limb and an extender cuff.…”