Paradoxical Pulmonary Embolism With Spontaneous Aortocaval Fistula

Rango, Paola De; Parlani, Gianbattista; Cieri, Enrico; Verzini, Fabio; Isernia, Giacomo; Silvestri, Valeria; Cao, Piergiorgio

doi:10.1016/j.avsg.2011.06.011

Cited by 12 publications

(18 citation statements)

References 19 publications

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“…Cases related to iliac artery were three. Only two cases were treated by endovascular repair and other seven cases were treated by surgery and another case was described autopsy finding (3, 10) The present iliocaval fistula was the third case treated by endovascular repair.…”

Section: Discussionmentioning

confidence: 80%

“…Such fistula classically present with a triad of high-output heart failure, pulsatile abdominal mass with a bruit and unilateral leg ischemia or venous congestion (2). Paradoxical pulmonary embolism related with arteriovenous fistula is exceedingly rare, but this situation can be developed and is very serious complication of arteriovenous fistula (3). Therefore, prompt repair of arteriovenous fistula is mandatory to restore hemodynamics and prevent recurrent pulmonary embolism in such condition.…”

Section: Introductionmentioning

confidence: 99%

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Iliocaval Fistula Presenting with Paradoxical Pulmonary Embolism Combined with High-Output Heart Failure Successfully Treated by Endovascular Stent-Graft Repair: Case Report

Koh

Kim

et al. 2014

J Korean Med Sci

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A 51-yr-old man presented exertional dyspnea as a consequence of iliocaval fistula combined with paradoxical pulmonary embolism and high-output heart failure. Endovascular stent-graft repair was performed to cover iliocaval fistula and restore the heart function. After the procedure, dyspnea was improved and procedure related complication was not seen. A 6-month follow-up computed tomography showed regression of pulmonary thromboembolism and well-positioned stent-graft without graft migration, aortacaval communication or endoleak. Stent graft implantation should be considered an alternative of open repair surgery for treament of abdominal arteriovenous fisula, especially in patient with high risk for surgery.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Iliocaval Fistula Presenting with Paradoxical Pulmonary Embolism Combined with High-Output Heart Failure Successfully Treated by Endovascular Stent-Graft Repair: Case Report

Koh

Kim

et al. 2014

J Korean Med Sci

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“…Unusual presentations include a paradoxical pulmonary embolism from an aortic thrombus [10] and acute renal colic, with or without hematuria [11]. Also, increased myocardial oxygen demand following the spontaneous rupture of abdominal aortic aneurysm (AAA) into IVC may precipitate angina [12].…”

Section: Discussionmentioning

confidence: 99%

Aortocaval Fistula: A Rare Cause of Venous Hypertension and Acute Renal Failure

Takkar

Choi

Mastouri³

et al. 2012

Case Reports in Surgery

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Spontaneous rupture of abdominal aortic aneurysm into the inferior vena cava is rare and is associated with high mortality and morbidity. The clinical presentation can be variable and thus the diagnosis can be difficult. It can present with symptoms and signs of an abdominal emergency, venous hypertension, or systemic hypoperfusion. The traditional method of repair has been open surgery which is associated with high rate of complications. We report a case of aortocaval fistula (ACF) presenting with acute renal failure and heart failure, which was treated successfully with a novel, endovascular approach.

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“…ACF may present predominantly as in our case with respiratory symptoms, type 1 respiratory failure and signs of central venous congestion, suggesting an incorrect diagnosis of PE on clinical grounds. On the other hand, ACF may at times be complicated by paradoxical PE or IVC thrombosis with secondary PE [23,24] . Although renal impairment may be a concern; contrast imaging is warranted to diagnose or rule out concurrent PE if clinically suspected in such a situation as placement of an IVC filter may be required.…”

Section: Discussionmentioning

confidence: 99%

Multi-organ failure secondary to an aortocaval fistula-when should it be suspected?

Medani

Walker

Leavey

2015

CRIM

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Spontaneous aortocaval fistula (ACF) is a rare, life threatening complication of abdominal aortic aneurysms (AAA) which is seldom suspected clinically. We report a case of progressive multi-organ failure secondary to an ACF wherein a delayed diagnosis was followed by a successful outcome. A 67-year-old man presented with dyspnoea on exertion, cough, and night sweats for three weeks. Initial investigations showed type 1 respiratory failure and mild renal impairment. He was treated for a suspected respiratory tract infection and fluid overload but antibiotic and diuretic therapies were ineffective. Within the following 36 hours he developed progressive azotemia and acute liver failure. He had physical signs of predominantly right-sided heart failure with preserved left ventricular systolic function on echocardiogram. Abdominal ultrasound and a non-contrast computed tomography (CT) revealed mild hepatomegaly, a 10 cm AAA with no evident leak and unremarkable kidneys. Oliguria and metabolic acidosis ensued with rapid deterioration of renal function and hypotension necessitating continuous veno-venous hemofiltration with inotropic support. Hepatic and renal function improved within a week of intensive care therapy but signs of volume overload persisted. A contrast abdominal CT demonstrated an ACF, which was successfully managed by endovascular stent-grafting. This case highlights the importance of being alert to the haemodynamic consequences of aortocaval rupture particularly in the presence of a large AAA in a patient presenting with unexplained organ failure and hyperkinetic shock. Optimisation of supportive care impacts favourably on the perioperative course and overall prognosis of this rare condition.

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Paradoxical Pulmonary Embolism With Spontaneous Aortocaval Fistula

Cited by 12 publications

References 19 publications

Iliocaval Fistula Presenting with Paradoxical Pulmonary Embolism Combined with High-Output Heart Failure Successfully Treated by Endovascular Stent-Graft Repair: Case Report

Iliocaval Fistula Presenting with Paradoxical Pulmonary Embolism Combined with High-Output Heart Failure Successfully Treated by Endovascular Stent-Graft Repair: Case Report

Aortocaval Fistula: A Rare Cause of Venous Hypertension and Acute Renal Failure

Multi-organ failure secondary to an aortocaval fistula-when should it be suspected?

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