Surgical Repair of Arteriovenous Fistula Associated with Iinfrarenal Aorto-iliac Aneurysm: Report of Two Contrasting Cases

Kondo, Norihiro; Takahashi, Kenji; Takeuchi, Susumu; Itô, Kazuo

doi:10.3400/avd.cr.10.01037

Cited by 6 publications

(2 citation statements)

References 8 publications

(23 reference statements)

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“… 2 ) Some studies have reported an AVF located in the anterior wall of veins. 3 , 4 ) This case is quite rare in that the AVF associated with the aneurysm was located in the posterior wall of the CIV. The fistula was not directly visible in this case.…”

Section: Discussionmentioning

confidence: 90%

Surgical Repair of an Arteriovenous Fistula in the Posterior Wall of the Right Common Iliac Vein

Hachiro

Kinoshita

Suzuki

et al. 2018

Annals of Vascular Diseases

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We present the case of a right internal iliac artery aneurysm with arteriovenous fistula in the posterior wall of the right common iliac vein. The fistula would have been difficult to close using endovascular treatment. We strongly anticipated difficulty in controlling bleeding; therefore, we performed cardiopulmonary bypass. Closing the fistula with suture would have been difficult, so we ligated the right common iliac artery and vein around the aneurysm. Femoro–femoral bypass was also performed to preserve blood flow in the lower right leg. The use of cardiopulmonary bypass should be considered in such difficult cases.

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Section: Discussionmentioning

confidence: 90%

Surgical Repair of an Arteriovenous Fistula in the Posterior Wall of the Right Common Iliac Vein

Hachiro

Kinoshita

Suzuki

et al. 2018

Annals of Vascular Diseases

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“…Consequently, the traditional surgical operative risk based on aneurysmal excision, fistula closure and graft inclusion remained high for decades, with a mortality rate as high as 50 percent [Gilling-Smith 1991;Maeda 2007]. As an alternative, the exclusion techniqueoriginally developed for infra-renal aortic aneurysms [Corson 1987] -which includes division of the aorta with suture closure of the proximal and distal aspects of the aneurysm, and bypass of the excluded segment has also been utilized in the context of aortoiliac aneurysms with aortocaval fistula when fistula itself could not be closed during surgery [Woolley 1995;Batt 1996;Kondo 2011]. In recent years, evolving endovascular techniques have been utilized in this clinical entity with no perioperative mortality and a technical success rate of 96 percent [Antoniou 2009].…”

Section: Introductionmentioning

confidence: 99%

A Review of The Exclusion Technique As A Mode Of Surgical Repair In The Treatment Of Aortoiliac Aneurysms With Spontaneous Arteriovenous Fistulas

Kızıltan

2018

HSF

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Patients with aortoiliac aneurysms with arteriovenous fistulas are difficult to treat. The traditional mode of surgical repair using aneurysmal excision, fistula closure, and graft inclusion has been associated with high perioperative mortality. As an alternative, the exclusion technique also has been utilized. Over the years, the popularity and success rate of endovascular techniques have increased in the treatment of these patients, yet a technical failure during an endovascular repair always makes surgical repair inevitable. This paper aims to review the outcomes of aneurysmal exclusion as a modality of surgical repair in the treatment of patients with aortic and/or iliac aneurysms with arteriovenous fistulas. The literature in English was researched utilizing the MEDLINE database. Articles reporting on surgical exclusion of abdominal arterial aneurysms with arteriovenous fistulas were included. Overall, four cases in three patients and our unpublished experience in a fifth case were evaluated. There were two aortoiliac, one aortic, one secondary iliac, and one pure iliac artery aneurysm, all with fistulas into the venous system. All patients recovered well following the exclusion operations. There were no operative or 30-day mortalities. One patient had inferior vena cava obstruction. Another patient developed a secondary iliac artery aneurysm with iliac vein fistula two years postoperatively, due to an internal iliac artery, which was not ligated during the first operation. Reported data indicates that for patients who have aortoiliac aneurysms with arteriovenous fistulas, the exclusion technique is a viable surgical alternative either as a first-line choice or when other strategies are technically not feasible.

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Aortocaval Fistula: Is Endovascular Repair the Preferred Solution?

Orion

Beaulieu

Black

2016

Annals of Vascular Surgery

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Background To compare outcomes of open and endovascular repair of aortocaval fistulas (ACFs) in the setting of abdominal aortic aneurysms (AAAs). Methods A literature review was undertaken on Pubmed from 1999 to 2014 to identify reported cases of both endovascular and open repair of ACF, including the index case, presented here. Primary outcomes for endovascular repair were: complications, presence of endoleak, and death. Primary outcomes for open repair were: complications and death. Results Forty articles were reviewed with a total of 67 patients, including the index case. Endovascular approach was used in 26 patients (39%). Endoleaks were present in 50%, whereas similarly 46% of patients had a reported complication. Five deaths (19%) occurred in the endovascular group. Open repair was performed in 41 cases (61%). The rate of complication and the death in open repair were 36% and 12%, respectively (P = 0.327 and P = 0.910, respectively) compared with endovascular. Mean follow-up was 7.7 months for the endovascular group and 8.5 months in the open group. Conclusions Previous demonstrations of high morbidity and mortality with open repair of ACF in the setting of AAA have motivated endovascular approaches. However, endoleaks are a significant problem and were present in 50% of ACF cases. The continued presence of an endoleak in the setting of an ACF may result in persistence of the ACF, unlikely thrombosis of the endoleak, and continued sac enlargement. Endovascular repair presents theoretical benefit, yet is not associated with a reduced rate of complication or death versus open repair in this contemporary review.

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Surgical Repair of Arteriovenous Fistula Associated with Iinfrarenal Aorto-iliac Aneurysm: Report of Two Contrasting Cases

Cited by 6 publications

References 8 publications

Surgical Repair of an Arteriovenous Fistula in the Posterior Wall of the Right Common Iliac Vein

Surgical Repair of an Arteriovenous Fistula in the Posterior Wall of the Right Common Iliac Vein

A Review of The Exclusion Technique As A Mode Of Surgical Repair In The Treatment Of Aortoiliac Aneurysms With Spontaneous Arteriovenous Fistulas

Aortocaval Fistula: Is Endovascular Repair the Preferred Solution?

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