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Sohail AH, Cohen K, Ho K, Cimaroli S, Brathwaite CEM, Shin P. Incidental aortocaval fistula in the setting of an unruptured abdominal aortic aneurysm. J Surg Case Rep 2023; 2023:rjad384. [PMID: 37416494 PMCID: PMC10319617 DOI: 10.1093/jscr/rjad384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
An aortocaval fistula, a rare abnormal vascular communication between the aorta and inferior vena cava, is most commonly associated with abdominal aortic aneurysms (AAAs). Other factors leading to aortocaval fistula formation include atherosclerosis, collagen vascular diseases, vasculitis, hematogenous infections, prior spinal surgery, malignancy and radiation exposure. In rare instances, aortocaval fistulas may be discovered incidentally on abdominal imaging. We report an unusual case of an incidental aortocaval fistula in a 93-year-old male patient with an unruptured AAA, presenting with shortness of breath, malaise and lethargy. The patient had no other obvious risk factors for aortocaval fistula formation. Multidetector computed tomography angiography helped identify the fistula, and the patient was eventually transferred to hospice for comfort measures. This case highlights the importance of detailed imaging and preoperative planning in managing aortocaval fistulas and associated AAAs.
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Affiliation(s)
- Amir H Sohail
- Department of Surgery, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Koral Cohen
- Correspondence address. Department of General Surgery, NYU Long Island School of Medicine, Mineola, NY, USA. Tel: 201-414-2434; Fax: 516-663-8707; E-mail:
| | - Kimberly Ho
- Department of Surgery, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Sawyer Cimaroli
- Department of Surgery, NYU Long Island School of Medicine, Mineola, NY, USA
| | | | - Patrick Shin
- Department of Surgery, NYU Long Island School of Medicine, Mineola, NY, USA
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2
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Naouli H, Jiber H, Bouarhroum A. Iliac arteriovenous fistula following lumbar disc surgery. A case report. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:199-202. [PMID: 36344032 DOI: 10.1016/j.jdmv.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Iliac arteriovenous (AV) fistula after lumbar disc surgery are uncommon entities with limited reported cases. This report describes a 44-year-old man with history of L4-L5 spinal discectomy who complained of congestive heart failure symptoms four years later. Computed tomography angiography (CTA) revealed an AV fistula connecting the right common iliac artery and vein. AV closure with lateral suturing of common iliac artery and vein was performed through transperitoneal aorto-iliac approach. Postoperatively, the patient's symptoms of orthopnea resolved. Follow-up at six years was uneventful.
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Affiliation(s)
- H Naouli
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University Boite Postale 1893 - KM 2.200, route Sidi Harazem Fès, 30070 Morocco; Vascular surgery department, UHC Hassan II Fez, Morocco.
| | - H Jiber
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University Boite Postale 1893 - KM 2.200, route Sidi Harazem Fès, 30070 Morocco; Vascular surgery department, UHC Hassan II Fez, Morocco
| | - A Bouarhroum
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University Boite Postale 1893 - KM 2.200, route Sidi Harazem Fès, 30070 Morocco; Vascular surgery department, UHC Hassan II Fez, Morocco
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3
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Endovascular Repair of a Large Ilioiliac Fistula Using a Reversed Iliac Limb Endograft. Ann Vasc Surg 2018; 56:354.e11-354.e15. [PMID: 30500655 DOI: 10.1016/j.avsg.2018.08.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/14/2018] [Accepted: 08/21/2018] [Indexed: 11/21/2022]
Abstract
Ilioiliac fistulae are a rare condition, for which diagnosis and treatment can be challenging. In this report, we describe the case of a 74-year-old patient with a high-flow fistula between the left common iliac artery and the ipsilateral common iliac vein presenting with heart failure. The fistula was probably iatrogenic, caused by prostatic surgery 1 year earlier. We describe imaging findings on computed tomography angiography and the treatment by 2 back-table reversed stent grafts. The satisfactory results demonstrated in our case and those in the literature suggest that an endovascular treatment for this rare condition should be considered as the first-line therapy.
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Singh N, Kuriakose AM, George RA, Vaidya S. Computed tomographic diagnosis of aortocaval fistula. SA J Radiol 2018; 22:1363. [PMID: 31754508 PMCID: PMC6837780 DOI: 10.4102/sajr.v22i1.1363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/21/2018] [Indexed: 11/17/2022] Open
Abstract
Aortocaval fistula is an abnormal vascular communication between an aortic aneurysm and the inferior vena cava. The condition is very rare and life threatening with high mortality. This article reports a case of aortocaval fistula in a 76-year-old male diagnosed using computed tomography. Computed tomography, being a non-invasive investigation, ensures early diagnosis and can help in prompt surgical or interventional radiological management which can be life-saving.
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Affiliation(s)
- Navdeep Singh
- Department of Radiodiagnosis, Jubilee Mission Medical College and Research Institute, India
| | | | - Regi An George
- Department of Radiodiagnosis, Jubilee Mission Medical College and Research Institute, India
| | - Shirish Vaidya
- Department of Radiodiagnosis, Jubilee Mission Medical College and Research Institute, India
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5
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Leon LR, Arslan B, Ley E, Labropoulos N. Endovascular Therapy of Spontaneous Aortocaval Fistulae Associated with Abdominal Aortic Aneurysms. Vascular 2016; 15:35-40. [PMID: 17382053 DOI: 10.2310/6670.2007.00011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case of an abdominal aortic aneurysm (AAA) associated with an aortocaval fistula managed with endovascular techniques. The patient had a known AAA, and on the latest computed follow-up tomographic scan, evidence of fistulization between the aorta and the vena cava was suggested, which was later corroborated by standard contrast angiography. His comorbidities precluded an open repair, and this prompted consideration for an endovascular intervention. Successful exclusion of the AAA was performed, with no evidence of endoleaks or persistence of the fistula. The endovascular approach provides an efficacious alternative to traditional methods for repair of an aortocaval fistula, which is especially important in elderly patients with several comorbidities.
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Affiliation(s)
- Luis R Leon
- Department of Vascular Surgery, Southern Arizona Veterans' Affairs Health Care System, 3601 South 6th Avenue, Tucson, AZ 85723, USA.
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6
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Clinical manifestations of aortocaval fistulas in ruptured abdominal aortic aneurysm: report of two cases. Case Rep Surg 2012; 2012:123081. [PMID: 23150843 PMCID: PMC3488385 DOI: 10.1155/2012/123081] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 10/09/2012] [Indexed: 11/17/2022] Open
Abstract
Aortocaval fistula (ACF) is an unusual complication of ruptured abdominal aortic aneurysm (AAA), involving less than 3-6% of all ruptured cases. The clinical presentation is often obscure, depending on the coexistence of retroperitoneal rupture and hemodynamic instability. Prompt preoperative diagnosis is essential in order to plan the operative approach and improve patient's outcome. We report the surgical treatment of two patients presented in the emergency department with ACF due to ruptured AAA, each with different clinical presentation, emphasizing the high index of suspicion needed by the clinician to early diagnose and treat this often lethal condition. Operative strategy and special considerations in the management of this subgroup of patients are also discussed.
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Bifurcated endograft repair of ilio-iliac arteriovenous fistula secondary to lumbar diskectomy. Ann Vasc Surg 2010; 24:551.e13-7. [PMID: 20144531 DOI: 10.1016/j.avsg.2009.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 08/18/2009] [Indexed: 11/23/2022]
Abstract
Ilio-iliac arteriovenous (AV) fistula is a rare complication after lumbar diskectomy. Endovascular repair of such fistulas is a growing trend in vascular surgery. This is a case report of an endovascular exclusion of an ilio-iliac AV fistula in a 51-year-old male. This man presented with high-output congestive heart failure and ascites. The AV fistula was discovered 17 years after a lumbar diskectomy. Computed topography (CT) revealed a right common iliac artery pseudoaneurysm connecting to the left common iliac vein. The fistula was repaired using a bifurcated Gore Excluder endograft. There were follow-up CT scans at 6 and 10 months confirming exclusion of the AV fistula. Endovascular AV fistula repair offers a safe, effective method for managing ilio-iliac AV fistulas.
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Antoniou GA, Koutsias S, Karathanos C, Sfyroeras GS, Vretzakis G, Giannoukas AD. Endovascular stent-graft repair of major abdominal arteriovenous fistula: a systematic review. J Endovasc Ther 2009; 16:514-23. [PMID: 19702345 DOI: 10.1583/09-2725.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the outcomes of endovascular stent-graft repair of major abdominal arteriovenous fistulas. METHODS The English literature was systematically searched using the MEDLINE electronic database up to January 2009. All reports on endovascular stent-graft repair of major abdominal arteriovenous fistula were considered. Our experience of abdominal arteriovenous fistula was involved in the data analysis. The primary outcome measures were technical success and perioperative, 30-day, and overall mortality. RESULTS Data for the final analysis were extracted from 21 papers reporting on 22 patients and from the medical records of a patient treated at our institution. The most common causal associations of these fistulae were the presence of an aortoiliac aneurysm and previous endovascular aneurysm repair, accounting for 56% and 13% of all associations, respectively. The technical success rate was 96% (22/23). No perioperative or 30-day mortality was noticed during a mean follow-up of 9 months. The most common procedure-related complication was type II endoleak, which was found in 22% (5/23) of the patients. This event was either self limiting or required minimal percutaneous intervention. CONCLUSION Endovascular stent-graft repair of major abdominal arteriovenous fistula is a safe and effective treatment option, with good short- and midterm results. However, no long-term data exist, and larger series are required to draw solid conclusions regarding the outcomes of this method.
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Affiliation(s)
- George A Antoniou
- Departments of Vascular Surgery, University of Thessaly Medical School, Larissa, Greece
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Bhatia M, Platon A, Khabiri E, Becker C, Poletti PA. Contrast enhanced ultrasonography versus MR angiography in aortocaval fistula: case report. ACTA ACUST UNITED AC 2009; 35:376-80. [DOI: 10.1007/s00261-009-9507-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 02/19/2009] [Indexed: 10/21/2022]
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11
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Taneja M, Metupalle V, Hiong TK, Soo TB, Htoo A. Postnephrectomy fistula between the renal artery stump and inferior vena cava treated with Amplatzer vascular plug: gray-scale and Doppler sonographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:497-499. [PMID: 18446858 DOI: 10.1002/jcu.20467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Fistulous communication between the renal artery stump and the inferior vena cava is a rare complication of nephrectomy. We report a case of an adult male in whom a fistula was detected on investigation for persistent postoperative anemia. The fistula was initially identified with Doppler sonography and subsequently confirmed on a catheter angiogram. It was successfully occluded percutaneously with an Amplatzer vascular plug. The plug had a distinctive appearance on subsequent sonographic studies that was useful for follow-up evaluation.
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Affiliation(s)
- Manish Taneja
- Department of Diagnostic and Vascular Interventional Radiology, Singapore General Hospital, Singapore
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13
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Clevert DA, Stickel M, Flach P, Strautz T, Horng A, Jauch KW, Reiser M. Contrast-enhanced ultrasound in detection and follow-up of an infrarenal abdominal aortic aneurysm with aorto-caval fistula and endovascular treatment. Cardiovasc Intervent Radiol 2007; 30:480-4. [PMID: 17205366 DOI: 10.1007/s00270-006-0143-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An aorto-caval fistula is a rare complication of a symptomatic or ruptured infrarenal aortic aneurysm having a frequency of 3-6%. Patients typically present with clinical signs of diffuse abdominal pain associated with increasing venous congestion and tachycardia, rapid cardiopulmonary decompensation with acute dyspnea, and an audible machinerylike bruit. Perioperative mortality is high, ranging from 20% to 60%. We report a case of an endovascular aortic repair in a patient with a symptomatic infrarenal aortic aneurysm and an aorto-caval fistula. Contrast-enhanced ultrasound seems to be a promising new diagnostic option for the diagnosis and preoperative treatment planning for patients with abdominal aortic aneurysms with rupture into the inferior vena cava. It is in addition to computed tomography angiography. It might allow a more rapid and noninvasive diagnosis, especially for patients in intensive care because of its bedside availability. Because the examination is dynamic, additional information about blood flow between the aorta and inferior cava vein can be evaluated.
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Affiliation(s)
- D-A Clevert
- Department of Clinical Radiology, University of Munich-Grosshadern Campus, Munich, Germany.
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O'Brien J, Buckley O, Torreggiani W. Hemolytic anemia caused by iatrogenic arteriovenous iliac fistula and successfully treated by endovascular stent-graft placement. AJR Am J Roentgenol 2007; 188:W306. [PMID: 17312042 DOI: 10.2214/ajr.06.0608] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Clevert DA, Stickel M, Johnson T, Glaser C, Clevert DA, Steitz HO, Kopp R, Jauch KW, Reiser M. Imaging of aortic abnormalities with contrast-enhanced ultrasound. A pictorial comparison with CT. Eur Radiol 2007; 17:2991-3000. [PMID: 17219146 DOI: 10.1007/s00330-006-0542-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 10/25/2006] [Accepted: 11/17/2006] [Indexed: 10/23/2022]
Abstract
Aortic abnormalities are commonly encountered and may represent a diagnostic challenge in patients with acute or chronic clinical symptoms. Contrast-enhanced ultrasound (CEUS) with low mechanical index (low MI) is a new promising method in the diagnosis and follow-up of pathological aortic lesions. CEUS with SonoVue allows a more rapid and noninvasive diagnosis, especially in critical patients because of its bedside availability. This review compares CEUS findings with those documented on computed tomography angiography (CTA), allowing the reader to appreciate the usefulness of CEUS in this clinical situation.
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Affiliation(s)
- D-A Clevert
- Department of Clinical Radiology, University of Munich-Grosshadern, Munich, Germany.
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Salerno S, Romano I, De Luca T, Lo Casto A. MDCT and virtual angioscopy in spontaneous aortocaval fistula. Int J Cardiovasc Imaging 2006; 23:635-8. [PMID: 17009085 DOI: 10.1007/s10554-006-9158-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 08/21/2006] [Indexed: 10/24/2022]
Abstract
Aortocaval fistula is a rare, less than 1%, but life threatening complication, of abdominal aortic aneurysm. Mortality is high but prompt recognition of the fistula can reduce mortality rate. The multidetector row CT (MDCT) findings in a 69-year-old patient with a complex medical history characterized by previous episodes of myocardial ischemia, is reported. MDCT shows an early homogeneous enhancement of the inferior vena cava, slightly dilated at the liver level and markedly narrowed above the renal vein due to aneurysm compression. The patient underwent to emergency laparotomy but died during surgery for cardiac arrest. MDCT allows a prompt recognition of the fistula and different computerized reconstruction techniques as maximum intensity projection (MIP), multiplanar reformatting (MPR) and virtual angioscopy (VA) added imaging information for surgery.
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MESH Headings
- Aged
- Angioscopy/methods
- Aorta/pathology
- Aorta/surgery
- Aortic Aneurysm, Abdominal/complications
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/pathology
- Aortic Aneurysm, Abdominal/surgery
- Aortography/methods
- Arteriovenous Fistula/diagnostic imaging
- Arteriovenous Fistula/etiology
- Arteriovenous Fistula/pathology
- Arteriovenous Fistula/surgery
- Fatal Outcome
- Humans
- Imaging, Three-Dimensional
- Male
- Phlebography/methods
- Radiographic Image Interpretation, Computer-Assisted
- Tomography, X-Ray Computed
- User-Computer Interface
- Vascular Surgical Procedures
- Vena Cava, Inferior/diagnostic imaging
- Vena Cava, Inferior/pathology
- Vena Cava, Inferior/surgery
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Affiliation(s)
- Sergio Salerno
- Sezione di Radiologia DIBIMEL, Policlinico Università di Palermo, Via Cardinale Rampolla 1, Palermo 90142, Italy.
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Iriz E, Ozdogan ME, Erer D, Uslu M, Koksal P, Kurtipek O. A giant aortocaval fistula due to abdominal aortic aneurysm. Int J Cardiol 2006; 112:e78-80. [PMID: 16891016 DOI: 10.1016/j.ijcard.2006.03.075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Accepted: 03/25/2006] [Indexed: 10/24/2022]
Abstract
Although very rare, the fistula development between vena cava inferior and an abdominal aortic aneurysm is a pathology which can deteriorate the clinical status of the patient rapidly. Today, this pathology can be diagnosed very easily with non-invasive tests, and invasive tests can also be used for diagnostic purposes when needed. Especially spiral computed tomography scan with contrast is usually sufficient to diagnose this pathology. A large-diameter aortocaval fistula case, which to our knowledge never presented in the literature before, and its diagnosis and treatment will be presented in this article.
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18
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Adili F, Balzer JO, Ritter RG, Schmandra TC, Tenholt M, Vogl TJ, Schmitz-Rixen T. Ruptured abdominal aortic aneurysm with aorto-caval fistula. J Vasc Surg 2004; 40:582. [PMID: 15337896 DOI: 10.1016/s0741-5214(03)00921-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Farzin Adili
- Division of Vascular and Endovascular Surgery, Univesrity of Frankfurt Medical Center, Germany
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Lau LL, O'reilly MJ, Johnston LC, Lee B. Endovascular stent-graft repair of primary aortocaval fistula with an abdominal aortoiliac aneurysm. J Vasc Surg 2001; 33:425-8. [PMID: 11174799 DOI: 10.1067/mva.2001.111485] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A primary aortocaval fistula is present in less than 1% of all abdominal aortic aneurysms. Until recently, surgical repair was the only method of treatment and was associated with a high incidence of morbidity and mortality. With the rapid development of aortic stent-graft technique, endovascular stent-graft repair may offer an alternative to the management of this often fatal condition. We report a case of an aortoiliac aneurysm with an aortocaval fistula successfully treated with endovascular stent-grafting. The unique hemodynamic changes, technical problems, and complications associated with this case are discussed, and the literature is reviewed.
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Affiliation(s)
- L L Lau
- Vascular Surgery Unit, and the Department of Radiology, Belfast City Hospital, Northern Ireland.
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20
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Ferrari M, Bonanomi G, Fossati N, Boggi U, Neri E, Mosca F. Surgical management of inflammatory abdominal aortic aneurysm associated with occult aortocaval fistula. Surgery 2000; 127:234-6. [PMID: 10686992 DOI: 10.1067/msy.2000.102755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- M Ferrari
- Department of Oncology, University of Pisa, Italy
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