Iliac arteriovenous fistula presenting with ascites

Abstract

Arteriovenous fistula presents rarely with ascites. Diagnosis, with an elusive clinical presentation, is often incidental or delayed. A 35-year-old woman presented with ascites and cardiac decompensation. Contrast enhanced computed tomography revealed arteriovenous fistula between the left common iliac artery aneurysm and the left common iliac vein. The patient underwent endovascular treatment with arterial access was performed, with implantation of a stent graft in the iliac artery to cover the fistulous communication. At follow-up 1 month later, she was asymptomatic without ascites. Arteriovenous fistula should be considered in the differential diagnosis of patients with ascites and cardiac decompensation. The endovascular treatment of the arteriovenous fistula should be considered as a first line option. Keywords: Arteriovenous fistula, ascites, heart failure, endovascular procedures INTRODUCTIONAbdominal arteriovenous (AV) fistulas are rare clinical abnormalities with a rupture of an aortic or iliac aneurysm into the inferior vena cava, the iliac or renal veins (1). Clinical presentation can vary greatly but commonly includes back pain, high-output congestive cardiac failure and the presence of an abdominal bruit. Diagnosis, with an elusive clinical presentation, is often incidental or delayed (1). Clinical presentation with ascites is rare in iliac AV fistulas (2).Surgery is the traditional treatment for this condition, consisting of fistula closure and aneurysm repair, usually with an aortic or aortoiliac graft (3). Endovascular repair of such fistulas is a growing trend in vascular surgery (4). This is a case of a percutaneous endovascular exclusion of an ilio-iliac AV fistula in a 35-year-old female presenting with ascites and swelling in the legs. CASE PRESENTATIONA 35-year-old woman was referred to our out-patients clinic with ascites. She has a five months history of increased abdominal girth and breath shortness. Her complaints started and increased gradually after lumbar discectomy five month prior to admission. Physical examination revealed a blood pressure, 100/70 mm Hg; heart rate, 86 beats/min; respiratory rate, 24 breaths/min; and temperature, 36°C. Skin and sclerae were anicteric. The lungs had bilateral basal crepitations without evidence of pleural effusion. Grade 3/6 holosystolic murmur was best heard at the left midsternal border. The abdomen was massive distended with a fluid wave and shifting dullness consistent with ascites. Examination over the left lower quadrant in the abdomen revealed a thrill and bruit. Bilateral asymmetrical lower extremity edema to the ankle was noted. 2014; 25 (Suppl.- Turk J Gastroenterol 211Initial laboratory examination showed moderate bilirubin elevation with total bilirubin 1.9 mg/dL and conjugated bilirubin 0.4 mg/dL. Electrocardiogram showed normal sinus rhythm. Chest radiograph showed cardiomegaly. Abdominal ultrasonography showed advanced ascites. By color doppler ultrasonography, portal vein diameter was measured 10 mm at its midpoint. Portal ...

Same features, different diagnosis: A case of ilio-iliac arteriovenous fistula presenting as decompensated heart failure

“…An ilio-iliac arteriovenous fistula presenting with decompensated heart failure, ascites and deranged liver and kidney function is rare. 1 , 2 This case was more unusual as the patient had a previous history of heart failure attributed to alcohol-related dilated cardiomyopathy that recovered completely after a period of alcohol abstinence. Causes and presenting features of an arteriovenous fistula are quite varying and depend on their location, size, duration, calibre of vessels and the cardiopulmonary reserve of the patient.…”