The Successful Treatment of an Ilio-Iliac Fistula and Aneurysms Affecting the Abdominal Aortic and Iliac Arteries via Endovascular Stent Graft Repair

Abstract

Spontaneous ilio-iliac arteriovenous fistula (AVF) associated with aneurysms affecting the abdominal aortic and iliac arteries is a rare condition. The classical clinical symptoms of ilio-iliac AVF include high-output heart failure, abdominal pain, abdominal bruits and thrills, a pulsatile abdominal mass, and venous congestion symptoms (leg edema and hematuria). The prompt repair of AVF is necessary to restore the patient’s hemodynamics. We report a case in which a patient with aneurysms affecting the abdominal aortic and iliac arteries and an ilio-iliac AVF presented with high-output heart failure and leg ischemia and was successfully treated via endovascular stent graft repair.

Endovascular repair of an ilio-iliac arteriovenous fistula following rupture of common iliac artery aneurysm with an aortic extension cuff in common iliac vein

“…Sueyoshi et al reported a case involving a long stent limb placement (16–20/124 mm) into the venous side because the exact AVF site could not be located during EVAR. [ 12 ] They reported that the venous site was excluded, but the stent-graft was occluded due to the pressure from the iliac aneurysm. Therefore, they recommended the use of short stent-grafts with radial force on the vein side.…”

“…With advances in endovascular techniques, less invasive endovascular repair has been performed when anatomically and technically suitable [8,11,12] . This complicated condition is considered difficult to treat by conventional EVAR since it cannot block the blood flow from the vein to the aneurysm sac.…”

“…[2,3] With advances in endovascular techniques, less invasive endovascular repair has been performed when anatomically and technically suitable. [8,11,12] This complicated condition is considered difficult to treat by conventional EVAR since it cannot block the blood flow from the vein to the aneurysm sac. The alternative solution to this is by graft stenting in the vein, but this can only be considered in traumatic or iatrogenic injury-related cases.…”

“…Accordingly, iliac extension limbs or aortic extension cuffs, or thoracic stent-grafts can be used, after selecting the diameter or length of the available stent-graft, especially in emergencies. Sueyoshi et al reported a case involving a long stent limb placement (16–20/124 mm) into the venous side because the exact AVF site could not be located during EVAR [12] . They reported that the venous site was excluded, but the stent-graft was occluded due to the pressure from the iliac aneurysm.…”