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Kimura T, Okada T, Obata N, Motoyama Y, Nagae M. Right-to-left shunt due to iatrogenic atrial septal defect manifested by aorto-caval fistula: a case report. JA Clin Rep 2024; 10:50. [PMID: 39145799 PMCID: PMC11327224 DOI: 10.1186/s40981-024-00735-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND An aorto-caval fistula is a rare but critical complication of abdominal aortic aneurysm (AAA) rupture, leading to high-output heart failure and increased venous pressure. The anesthetic management of such cases, particularly when complicated by an intraoperative right-to-left shunt, is seldom reported. CASE PRESENTATION A 71-year-old man with a history of atrial fibrillation and catheter ablation presented with heart failure and abdominal pain, leading to cardiac arrest. Imaging revealed an AAA rupture into the inferior vena cava. During emergency surgery, severe venous bleeding was managed using intra-aortic balloon occlusion (IABO). Transesophageal echocardiography (TEE) identified a right-to-left shunt due to an iatrogenic atrial septal defect. CONCLUSION Early TEE recognition and timely IABO intervention were crucial in managing this complex case, underscoring the importance of these techniques in similar emergency scenarios.
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Affiliation(s)
- Takuya Kimura
- Department of Anesthesiology and Pain Clinic, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-Cho, Himeji, Hyogo, 670-8560, Japan
| | - Takuya Okada
- Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan.
| | - Norihiko Obata
- Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Yasushi Motoyama
- Department of Anesthesiology and Pain Clinic, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-Cho, Himeji, Hyogo, 670-8560, Japan
| | - Masaharu Nagae
- Department of Anesthesiology and Pain Clinic, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-Cho, Himeji, Hyogo, 670-8560, Japan
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2
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McDonald M, Robinson E, Singh H. Staged triple endovascular approach for repair of aortocaval fistula secondary to ruptured abdominal aortic aneurysm. J Vasc Surg Cases Innov Tech 2023; 9:101335. [PMID: 38023326 PMCID: PMC10654583 DOI: 10.1016/j.jvscit.2023.101335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/12/2023] [Indexed: 12/01/2023] Open
Abstract
A primary aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysms caused by erosion of the aortic wall into the vena cava. It is more frequently observed in the setting of ruptured abdominal aortic aneurysms and presents a unique challenge for vascular surgeons. Both open and endovascular techniques exist, with the main differences being perioperative mortality and recurrence rates. We present a case of an ACF diagnosed intraoperatively, which persisted after endovascular aneurysm repair in conjunction with a type II endoleak. We applied a unique staged, triple endovascular approach to close the ACF via caval and aortic exclusion of inflow and outflow vessels.
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Affiliation(s)
- Molly McDonald
- Division of Vascular Surgery, Department of Surgery, Mount Sinai South Nassau, Mount Sinai Health System, New York, NY
| | - Eric Robinson
- Division of Vascular Surgery, Department of Surgery, Mount Sinai South Nassau, Mount Sinai Health System, New York, NY
| | - Harmandeep Singh
- Division of Vascular Surgery, Department of Surgery, Mount Sinai South Nassau, Mount Sinai Health System, New York, NY
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3
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Khalil M, Almazrooa A. Endovascular aneurysm repair of aortocaval fistula presenting with lower limb edema: A case report. Radiol Case Rep 2023; 18:3804-3808. [PMID: 37663561 PMCID: PMC10474353 DOI: 10.1016/j.radcr.2023.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023] Open
Abstract
Aortocaval fistula (ACF) due to a ruptured abdominal aortic aneurysm is an uncommon medical condition that can be fatal if not diagnosed. ACF has several atypical signs and symptoms, making it challenging to diagnose, and an early diagnosis notably improves outcomes. We report a case of a 64-year-old man presenting with a 1-day history of lower back pain, hypotension, and lower limb edema. Computed tomography angiography demonstrated an abdominal aortic aneurysm with ACF. An urgent endovascular aneurysm repair was successfully performed to treat the ACF in this patient. Eighteen months later, the patient had an intact stent, normalized renal function, and no edema.
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Affiliation(s)
- Mohammad Khalil
- Department of Radiology, Faculty of medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulrahman Almazrooa
- Department of Anesthesia and Intensive Care, Faculty of medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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4
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Aldahman RS, Alghadouni SA, Alharbi AS. A Rare Complication of Abdominal Aortic Aneurysm: A Case Report of Aortocaval Fistula. Cureus 2023; 15:e38106. [PMID: 37252494 PMCID: PMC10212722 DOI: 10.7759/cureus.38106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Aortocaval fistula is a rare but serious complication of an abdominal aortic aneurysm characterized by communication between the dilated abdominal aorta and inferior vena cava. Prompt diagnosis and treatment are essential to reduce the mortality rate. A 66-year-old man with a history of poorly controlled hypertension, diabetes mellitus, and dyslipidemia presented to the emergency department with sudden, severe lower back pain. Laboratory investigations showed a rapid drop in hemoglobin levels and increased lactate levels. A CT scan revealed an aortocaval fistula resulting from a rupture of the abdominal aorta. The patient underwent emergency surgery, but a cardiac arrest occurred during the procedure, and he could not be resuscitated. Despite advances in imaging and surgical techniques, the mortality rate of aortocaval fistula remains high. It is crucial for clinicians to maintain a high level of suspicion for aortocaval fistula in patients with an abdominal aortic aneurysm who present with a sudden onset of abdominal and back pain and to initiate appropriate resuscitative measures and an urgent surgical consultation.
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5
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Tanaka C, Furuya H, Kamei S, Suda S, Yamaguchi M. Endovascular Repair for Abdominal Aneurysm with Concomitant Aortoiliac Vein Fistula Diagnosed by Four-Dimensional Computed Tomography. Ann Vasc Dis 2022; 15:337-340. [PMID: 36644261 PMCID: PMC9816039 DOI: 10.3400/avd.cr.22-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/27/2022] [Indexed: 12/25/2022] Open
Abstract
A 78-year-old man complaining of left leg swelling was diagnosed with an abdominal aortic aneurysm with an irregular margin. A four-dimensional computed tomography (CT) showed an aortoiliac vein fistula. An AFX stent graft was urgently implanted, and a Viabahn VBX was inserted into the left iliac vein. The aneurysmal sac was embolized. After the procedure, enhanced CT confirmed a patent stent graft without any endoleak or fistula. The patient was discharged ambulatory. An aortoiliac vein fistula is a differential diagnosis for leg edema, and a four-dimensional CT is beneficial in diagnosing the condition.
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Affiliation(s)
- Chiharu Tanaka
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan,Corresponding author: Chiharu Tanaka, MD, PhD. Department of Cardiovascular Surgery, Tokai University Hachioji Hospital, Ishikawamachi 1838, Hachioji, Tokyo 192-0032, Japan Tel: +81-42-639-1111, Fax: +81-42-639-1112, E-mail:
| | - Hidekazu Furuya
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Shunsuke Kamei
- Department of Radiology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Satoshi Suda
- Department of Radiology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Masaomi Yamaguchi
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
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6
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Borkowski A, Młodzik J, Jodłowski G, Madurska M, Malinowski M, Skóra J, Janczak D. Type II endoleak accompanied by an arteriovenous fistula between the inferior mesenteric artery and the inferior vena cava as a complication of endovascular aneurysm repair. Proc (Bayl Univ Med Cent) 2022; 36:103-105. [PMID: 36578588 PMCID: PMC9762763 DOI: 10.1080/08998280.2022.2116759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Endovascular aneurysm repair (EVAR) has become one of the most important treatments for aortic abdominal aneurysm. This method has some possible complications, including a type II endoleak (T2E). When coexisting with arteriovenous fistulas (AVF), T2E can lead to serious hemodynamic consequences and organ failure. This report describes the management of a patient with T2E coexisting with AVF following an EVAR and re-EVAR procedure. Although T2E itself may be treated with a conservative approach in some cases, in the presented patient an operative approach was necessary because of coexisting AVF. In addition, due to unusual hemodynamic conditions created by concomitant ACF and T2E, fistula closure was obtained as a result of transarterial inferior mesenteric artery embolization. Post-EVAR imaging, including ultrasound and computed tomography angiography, has proven to be essential when caring for these patients.
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Affiliation(s)
- Artur Borkowski
- Department and Clinic of Vascular, General, and Transplantation Surgery, Jan Mikulicz-Radecki Medical University Hospital, Wroclaw Medical University, Wroclaw, Poland,Corresponding author: Artur Borkowski, MD, Mikulicz-Radecki Medical University Hospital, Borowska 213, 50-556Wroclaw, Poland (e-mail: )
| | - Jakub Młodzik
- Department and Clinic of Vascular, General, and Transplantation Surgery, Jan Mikulicz-Radecki Medical University Hospital, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Jodłowski
- Department and Clinic of Vascular, General, and Transplantation Surgery, Jan Mikulicz-Radecki Medical University Hospital, Wroclaw Medical University, Wroclaw, Poland
| | - Marta Madurska
- Department of Vascular Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Maciej Malinowski
- Department and Clinic of Vascular, General, and Transplantation Surgery, Jan Mikulicz-Radecki Medical University Hospital, Wroclaw Medical University, Wroclaw, Poland
| | - Jan Skóra
- Department and Clinic of Vascular, General, and Transplantation Surgery, Jan Mikulicz-Radecki Medical University Hospital, Wroclaw Medical University, Wroclaw, Poland
| | - Dariusz Janczak
- Department and Clinic of Vascular, General, and Transplantation Surgery, Jan Mikulicz-Radecki Medical University Hospital, Wroclaw Medical University, Wroclaw, Poland
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7
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Fatal Case of a Contained Ruptured of the Infrarenal Aorta due to Simultaneous Primary Aortocaval Fistula and Aortoenteric Fistula. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03071-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AbstractWe report an extremely rare case of primary aortocaval fistula with simultaneous development of an aortoenteric fistula in a 68-year-old man. The patient developed under oral anticoagulation a spontaneous intracaval aortic rupture. An emergency intervention was performed with a covering of the fistula with an aorto-uniiliac stent graft and a femoro-femoral crossover bypass. One week later, the patient was transferred to our institution with the diagnosis of a psoas abscess and a suspected concomitant aortoenteric fistula. We performed a complete explantation of the endograft and implanted it after extensive debridement an aortobiiliac bypass, made of bovine pericardium. The postoperative course was complicated, first by bleeding from the left iliac anastomosis, and then by bleeding from the proximal aortic anastomosis. The entire graft was explanted and an axillo-femoral bypass was implanted. The patient then developed a multi-organ failure and died 3 months later. If possible, an extended surgical debridement and resection of all infected tissue with in situ reconstruction is the gold standard. However, with this therapy, there is still a high risk of reinfection. Long-term antibiotic management is mandatory.
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8
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Braga D, Olivieri B, Zybulewski A, Ayad M. Transvenous Exclusion of a Type II Endoleak complicated by ilio-iliac AVF with Coils and Venous Stent Graft. J Vasc Interv Radiol 2022; 33:1010-1012. [PMID: 35577047 DOI: 10.1016/j.jvir.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/23/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Daniel Braga
- Department of Vascular and Interventional Radiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140; Department of Vascular and Endovascular Surgery, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140
| | - Brandon Olivieri
- Department of Vascular and Interventional Radiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140; Department of Vascular and Endovascular Surgery, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140
| | - Adam Zybulewski
- Department of Vascular and Interventional Radiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140; Department of Vascular and Endovascular Surgery, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140
| | - Michael Ayad
- Department of Vascular and Interventional Radiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140; Department of Vascular and Endovascular Surgery, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140
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9
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Morton C, Endicott KM, Penikis A, Toursavadkohi S, Hall MR. Ruptured Iliac Arteriovenous Fistula Presenting With Thigh Pain and Swelling: Case Report. Front Surg 2022; 9:834071. [PMID: 35372487 PMCID: PMC8966135 DOI: 10.3389/fsurg.2022.834071] [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: 12/12/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
The presentation of abdominal arteriovenous fistulas is classically described as a triad of a pulsatile abdominal mass with a bruit, high-output heart failure, and regional venous hypertension with primarily open operative therapy. In the following case, we present the treatment of a patient who arrived with acute right heart failure and renal failure due to an arteriovenous fistula and who was successfully treated with endovascular repair.
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Affiliation(s)
- Claire Morton
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, MD, United States
| | - Kendal M. Endicott
- Inova Heart and Vascular Institute, Inova Health Systems, Falls Church, VA, United States
| | - Annalise Penikis
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, MD, United States
| | - Shahab Toursavadkohi
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, MD, United States
| | - Michael R. Hall
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, MD, United States
- *Correspondence: Michael R. Hall
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10
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Charif F, Nassar P, Youssef D, Neghawi Z, Saab M. High Output Heart Failure Secondary to Aorto-Caval Fistula Treated With an Amplatzer Septal Occluder: Case Report and Review of Literature. Cureus 2021; 13:e14430. [PMID: 33996296 PMCID: PMC8114586 DOI: 10.7759/cureus.14430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aorto-caval fistula (ACF) is a rare cause of high output heart failure (HOHF). 80 % of cases are due to ruptured abdominal aortic aneurysm, while 10 to 20% are traumatic or congenital. Early diagnosis and treatment are crucial in order to prevent the progression to HOHF. Open surgical repair has been the mainstay therapy of arterio-venous fistulas including aorto-caval fistula; however endovascular approach has become an evolving therapeutic option in the last 20 years. Here, we present a case of high output heart failure secondary to traumatic aorto-caval fistula due to shrapnel injury to the abdomen. Our patient was managed with endovascular approach by the deployment of amplatzer septal occluder that excluded completely the fistula, resulting in the progressive improvement of HOHF. In this manuscript, we review etiologies of high output heart failure and summarize cases of aorto-caval fistula treated with amplatzer septal occluder reported in literature. We also highlight the importance of this endovascular device in the presence of metallic foreign body in the aorta.
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Affiliation(s)
- Fida Charif
- Pulmonary Critical Care Medicine, Beirut Cardiac Institute, Beirut, LBN
| | - Pierre Nassar
- Adult Cardiology Division, Beirut Cardiac Institute, Beirut, LBN
| | - Dani Youssef
- Pediatric Cardiology, Beirut Cardiac Institute, Beirut , LBN
| | - Ziad Neghawi
- Radiology Division, Beirut Cardiac Institute, Beirut, LBN
| | - Mohamad Saab
- Cardio-vascular Surgery Division, Beirut Cardiac Institute, Beirut, LBN
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11
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de Oliveira C, Schmid BP, Molinari GJDP, Guillaumon AT. Abdominal aortic aneurysms ruptured to the vena cava: a case series and literature review. J Vasc Bras 2021; 20:e20200174. [PMID: 34093691 PMCID: PMC8147892 DOI: 10.1590/1677-5449.200174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Ruptured abdominal aortic aneurysms (RAAA) evolving aortocaval fistula (AF) can have catastrophic hemodynamic effects. Surgical repair is imperative, but the optimal technical approach is still under debate. Our objective is to present 3 cases treated with endovascular repair (EVAR) at a University Hospital. Case #1, a 71-year-old man presenting a 7.1cm RAAA with AF, repaired with a monoiliac stent graft and femoral-femoral bypass; Case #2, a 76-year-old man presenting a 9.9cm RAAA with AF, repaired with a bifurcated stent graft; Case #3, a 67-year-old man with previous history of EVAR, presenting a type 3 endoleak with late rupture related to AF, repaired with a tubular stent graft. All cases unfolded with delayed recovery and significant complication rates, although AF symptoms had resolved by hospital discharge. EVAR techniques for AF may require secondary interventions but are feasible, despite the lack of consensus, considering the rarity of this RAAA presentation.
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12
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Wang T, Zhao J, Yuan D. Endovascular treatment of an ilio-iliac arteriovenous fistula accompanied by venous thromboembolism presenting with multiple organ failure - A case report and literature review. Vascular 2021; 30:162-166. [PMID: 33663299 DOI: 10.1177/1708538121996576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Multiple organ failure is a rare manifestation of ilio-iliac arteriovenous fistula which can lead to a high rate of misdiagnosis and death. METHODS We reported a 61-year-old man presenting with multiple organ failure rapidly after right lower limb swelling. Computed tomography angiography showed an ilio-iliac arteriovenous fistula caused by right common iliac artery aneurysm, and venous thrombosis of bilateral common iliac veins. A bifurcated stent-graft with coil embolization of right internal iliac artery was used for repair. RESULTS The patient recovered rapidly and was discharged without complications. Although arteriovenous fistula persisted due to type II endoleak, aneurysm sac and inferior vena cava significantly shrunk at six months follow-up. CONCLUSIONS This report demonstrated that multiple organ failure may appear when the distal outflow tracts of arteriovenous fistula are obstructed. Moreover, endovascular repair is effective for reversal of multiple organ failure caused by arteriovenous fistula, even if arteriovenous fistula persists due to type II endoleak.
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Affiliation(s)
- Tiehao Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Sichuan, P.R. China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital, Sichuan University, Sichuan, P.R. China
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital, Sichuan University, Sichuan, P.R. China
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13
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Fujimiya T, Seto Y, Ishida K, Takase S, Satokawa H, Yokoyama H. Impending rupture of abdominal aortic aneurysm due to spontaneous obstruction of aortocaval fistula after endovascular abdominal aortic aneurysm repair. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:219-222. [PMID: 33997557 PMCID: PMC8095077 DOI: 10.1016/j.jvscit.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/04/2021] [Indexed: 11/25/2022]
Abstract
Endovascular aortic aneurysm repair (EVAR) is a valid treatment for patients with abdominal aortic aneurysm with aortocaval fistula. However, an endoleak can be caused by persistent communication between the aneurysm and the inferior vena cava. We present a case of impending rupture due to spontaneous obstruction of an aortocaval fistula after EVAR. Spontaneous obstruction of an aortocaval fistula is rare; however, when occurs, it will cause an endoleak, followed by dilatation or impending rupture of the abdominal aortic aneurysm. EVAR alone for aortocaval fistula will sometimes not be adequate if the type II endoleak is patent.
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Affiliation(s)
- Tsuyoshi Fujimiya
- Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Japan
| | - Yuki Seto
- Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Japan
| | - Keiichi Ishida
- Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Japan
| | - Shinya Takase
- Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Japan
| | - Hirono Satokawa
- Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Japan
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Japan
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14
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Esmat HA, Naseri MW. Endovascular management of aortocaval fistula complicating abdominal aortic aneurysm presenting as an acute renal failure. Ann Med Surg (Lond) 2021; 62:477-480. [PMID: 33604036 PMCID: PMC7873572 DOI: 10.1016/j.amsu.2021.01.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Aortocaval fistulas (ACFs) are a rare complication of abdominal aortic aneurysm (AAA), associated with high morbidity and mortality. It is thought that increased tension in the walls of large aneurysms can cause an inflammatory reaction resulting in adhesion to the adjacent vein and culminating in necrosis of the adherent layers and fistula formation. Presentation of case A 70-year-old male was referred from a local state center to the emergency department of our hospital, complaining of weakness and oliguria for two days. The laboratory analysis yielded high urea and creatinine levels, indicating an acute renal failure. Computed tomography images showed an aortocaval fistula complicating infrarenal abdominal aortic aneurysm. The patient was successfully managed with endovascular intervention. Discussion Aortocaval fistulas generally affect elderly men with an average age of 65 years. The diagnosis is often delayed because of the variable clinical manifestations, which increases the difficulties in treatment. Conventional surgical intervention has high mortality rates. However, endoleaks and paradoxical pulmonary embolism are the main concerning complications of endovascular treatment. Conclusion Spontaneous aortocaval fistulas are a rare, but potentially life-threatening complication of abdominal aortic aneurysm with myriad clinical manifestations. Early diagnosis and management can directly affect the prognosis and outcome. Modern non-invasive diagnostic imaging can help timely diagnosis and provide a road map for the treatment plan. Endovascular repair is the first choice of treatment. However, a high incidence and persistence of endoleak with the endovascular approach requires caution and a close long time follow up. Spontaneous aortocaval fistulas are a rare complication of abdominal aortic aneurysm. Early diagnosis and management can directly affect the prognosis and outcome. Modern non-invasive diagnostic imaging can help timely diagnosis. Endovascular repair is the first choice of treatment.
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Affiliation(s)
- Habib Ahmad Esmat
- Department of Radiology, Kabul University of Medical Sciences, Kabul, Afghanistan
| | - Mohammad Wali Naseri
- Department of Internal Medicine, Division of Endocrinology, Metabolism, and Diabetes, Kabul University of Medical Sciences, Kabul, Afghanistan
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15
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Ascoli Marchetti A, Oddi FM, Diotallevi N, Battistini M, Ippoliti A. An unusual complication after endovascular aneurysm repair for giant abdominal aortic aneurysm with aortocaval fistula: High bilirubin levels. SAGE Open Med Case Rep 2020; 8:2050313X20984322. [PMID: 33489236 PMCID: PMC7768567 DOI: 10.1177/2050313x20984322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/03/2020] [Indexed: 11/21/2022] Open
Abstract
Abdominal aortic aneurysm has among its rare complications the aortocaval
fistula. It is observed in less than 1% of all abdominal aortic aneurysms and
represents 3%–7% of clinical presentation in case of rupture. A male patient was
presented to the emergency department with pulsating mass with continuous
vascular systo-diastolic bruit, located in the lower part of abdomen with the
back pain radiating anteriorly in lower abdomen. After diagnosis of abdominal
aortic aneurysm with aortocaval fistula, a trimodular Endurant endograft was
placed. Migration of the endoprosthesis was treated with Endoanchor and
endovascular aneurysm sealing device. In the postoperative course, the patient
had jaundice due to high bilirubin levels, cholestasis and increased hepatocyte
cytolysis: aspartate aminotransferase and alanine aminotransferase. The
treatment with appropriate continuous filtration rapidly reduced bilirubin
values and the patient gradually improved.
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Affiliation(s)
- Andrea Ascoli Marchetti
- Vascular Surgery Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Fabio Massimo Oddi
- Vascular Surgery Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Nicolò Diotallevi
- Vascular Surgery Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Martina Battistini
- Vascular Surgery Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Arnaldo Ippoliti
- Vascular Surgery Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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16
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Transvenous endovascular repair of symptomatic type II endoleak following endovascular repair of a ruptured common iliac aneurysm with arteriovenous fistula. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:614-617. [PMID: 33163744 PMCID: PMC7599385 DOI: 10.1016/j.jvscit.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022]
Abstract
Arteriovenous fistula (AVF) is an uncommon presentation of ruptured aortoiliac aneurysm (rAIA). Symptomatic persistence of an AVF fed by a type II endoleak after endovascular aneurysm repair (EVAR) for rAIA is rare, with little in the literature to guide practice. We present a novel transvenous approach to treatment of symptomatic type II endoleak after EVAR for rAIA with AVF. A transvenous approach avoids complex arterial access and the need for stenting in the venous system. This technique should be considered in patients with persistent AVF after EVAR with ongoing symptomatic type II endoleak.
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17
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Ponnuswamy KG, Reddy PR, Vadher A, Nanda S, Ojha V, Goyal A, Kumar S. Ruptured abdominal aortic aneurysm with aortocaval fistula and embolic IVC thrombus-a rare clinical scenario detected on CT angiography. Indian J Thorac Cardiovasc Surg 2020; 36:429-430. [PMID: 33061155 DOI: 10.1007/s12055-020-00937-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/02/2020] [Accepted: 02/05/2020] [Indexed: 11/29/2022] Open
Abstract
Rupture with fistulization of an abdominal aortic aneurysm with the vena cava is a rare complication and typically presents with congestive cardiac failure. Embolization of a thrombus from the aneurysm into the vena cava can however present in the absence of failure symptoms which can make it difficult to diagnose clinically without cross sectional imaging.
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Affiliation(s)
- Kartik Ganga Ponnuswamy
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Pradeep Ramakrishnan Reddy
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Akash Vadher
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Saurabh Nanda
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Aayush Goyal
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029 India
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18
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Tsolakis IA, Kakkos SK, Papageorgopoulou CP, Papadoulas S, Lampropoulos G, Fligou F, Nikolakopoulos KM, Ntouvas I, Kouri A. Predictors of Operative Mortality of 928 Intact Aortoiliac Aneurysms. Ann Vasc Surg 2020; 71:370-380. [PMID: 32890639 DOI: 10.1016/j.avsg.2020.08.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study is to identify preoperative and intraoperative factors associated with in-hospital mortality of intact abdominal aortoiliac aneurysm repair. METHODS In this observational study, prospectively collected information included demographics, risk factors, comorbidities, aneurysm characteristics (including special aneurysm presentation, i.e., inflammatory, mycotic/infected, aortocaval fistula), investigations, and operative variables. Receiver operating characteristic) curve analysis of the Glasgow aneurysm score (GAS) and the Vascular Study Group of New England (VSGNE) score was performed in the subgroup of bland aneurysms undergoing isolated elective repair. RESULTS A total of 928 cases with intact aortoiliac aneurysms had an elective (n = 882) or urgent (n = 46) repair, associated with an in-hospital mortality of 1.7% and 8.7%, respectively (P = 0.01). Open repair (n = 514) was a predictor of higher mortality (3.3% vs. 0.5% for endovascular aneurysm repair [EVAR], n = 414, odds ratio [OR] 7.1, P = 0.003), and so was the pre-EVAR era (4.8% vs. 1.3% in the EVAR era, OR 4.0, P = 0.004). Other significant predictors included the presence of abdominal/back pain (7.5% vs. 1.3%, OR = 6.0, P = 0.001), preoperative angiography (7% vs. 1.6%, OR = 4.5, P = 0.01), special aneurysm presentation (10.9% vs. 1.5%, OR = 8.1, P < 0.001), concomitant major procedures (19% vs. 1.7%, OR = 14.0, P < 0.001), serious intraoperative complications (9.1% vs. 1.5%, OR = 6.6, P = 0.001), median number of transfused units of blood intraoperatively (2 and 0 for cases with and without mortality, respectively, P < 0.001), and procedure duration (270 and 150 min for cases with and without mortality, respectively, P < 0.001). Open repair (OR = 4.5, P = 0.05), special aneurysm presentation (OR = 6.58, P = 0.001), and concomitant major procedures (OR = 14.3, P < 0.001) were independent predictors of higher mortality. ROC curve analysis for the GAS (P = 0.87) and VSGNE score (P = 0.10) failed to demonstrate statistical significance in the subgroup of bland aneurysms undergoing isolated elective repair. CONCLUSIONS Our study has demonstrated independent risk factors for mortality, which should be considered when contemplating aortoiliac aneurysm repair. We failed to externally validate the GAS and VSGNE score.
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Affiliation(s)
- Ioannis A Tsolakis
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
| | | | - Spyros Papadoulas
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - George Lampropoulos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Fotini Fligou
- Department of Anesthesiology and Intensive Care, University of Patras Medical School, Patras, Greece
| | | | - Ioannis Ntouvas
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Anastasia Kouri
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
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19
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Torrealba JI, Vargas JF, Mertens RA, Valdes FJ, Marine LA, Bergoeing MP. Endovascular Management of a Ruptured Iliac Aneurysm With an Inferior Vena Cava Fistula. Vasc Endovascular Surg 2020; 54:638-642. [PMID: 32662320 DOI: 10.1177/1538574420939724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aortocaval fistula is uncommon and often associated with a ruptured iliac or abdominal aortic aneurysm. It has a high mortality secondary to the aneurysmal rupture but also to a high output heart failure. Open surgery has been the standard; however, endovascular management has emerged with lower mortality. We present a patient with a ruptured iliac aneurysm and an inferior vena cava fistula successfully treated with an endograft with embolization of the right hypogastric artery. The patient arrested on induction and was resuscitated with aortic balloon inflation. Endovascular therapy can be safely used in the management of iliac/aortocaval fistula.
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20
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Dabbouseh NM, Mason PJ, Patel PJ, Rossi PJ. Endovascular repair of delayed traumatic aortocaval fistula. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:467-471. [PMID: 31763500 PMCID: PMC6859229 DOI: 10.1016/j.jvscit.2019.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/25/2019] [Indexed: 11/17/2022]
Abstract
Aortocaval fistula (ACF) is an uncommon condition that can result in a number of adverse clinical sequelae. We describe a case of an ACF that occurred several years after open repair of a penetrating injury of the abdominal aorta and inferior vena cava. Whereas ACF can have sudden and catastrophic presentations, our patient had a subacute presentation of high-output heart failure. We were able to fully correct the vascular injury and heart failure physiology and symptoms with endovascular therapy.
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Affiliation(s)
- Noura M. Dabbouseh
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisc
| | - Peter J. Mason
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisc
| | - Parag J. Patel
- Division of Vascular/Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisc
| | - Peter J. Rossi
- Division of Vascular and Endovascular Surgery, Medical College of Wisconsin, Milwaukee, Wisc
- Correspondence: Peter J. Rossi, MD, FACS, FSVS, Chief, Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226
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21
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Open Surgery and Endovascular Techniques in Treatment of Acute Abdominal Arteriovenous Fistulas. Ann Vasc Surg 2019; 61:427-433. [PMID: 31207397 DOI: 10.1016/j.avsg.2019.03.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/19/2019] [Accepted: 03/26/2019] [Indexed: 11/21/2022]
Abstract
Acute abdominal arteriovenous fistulas in the setting of ruptured abdominal aortic aneurysms are a life-threatening condition; thus, a prompt diagnosis is required for proper treatment. Open, endovascular, and hybrid repair have been proposed for their management, with pros and cons for each method. In particular, the evolution of endoluminal techniques guarantees an increasing feasibility of these procedures, and a significant reduction in morbidity and mortality rates was usually associated with open surgery. Nevertheless, some concerns still remain regarding the midterm and long-term follow-up. The aim of this article was to review and compare the reported clinical and technical results of conventional open surgery and endoluminal techniques in this scenario and to report the case of an acute aorto-iliac fistula due to a ruptured common iliac artery aneurysm into the iliac vein that was managed by endovascular repair at our institution.
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22
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Bitargil M, Bektas N, Omeroglu S, Koramaz I. Surgical Repair of a 13-cm Infrarenal Abdominal Aortic Aneurysm with Aortocaval Fistula in a 63-Year-Old Tuba Player. Tex Heart Inst J 2019; 46:36-40. [PMID: 30833836 DOI: 10.14503/thij-17-6370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Infrarenal abdominal aortic aneurysm with aortocaval fistula, a rare condition, can be fatal without prompt intervention. The clinical symptoms are complex and varied, so diagnosis is typically confirmed by use of contrast-enhanced multidetector computed tomography. We report our surgical repair of a 13-cm-diameter infrarenal abdominal aortic aneurysm and aortocaval fistula in a 63-year-old orchestral tuba player who had 2 classic symptoms of the condition. The unruptured aneurysm and fistula were complicated by acutely angled vessels, so we performed surgery rather than endovascular repair. The patient recovered fully and was discharged from the hospital. This infrarenal aneurysm with aortocaval fistula is perhaps the largest to have been treated successfully by means of open surgery. In addition to our patient's case, we discuss the history and treatment considerations of this rare combined condition.
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23
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Hanada K, Yamamoto K, Akai T, Taniguchi R, Takayama T, Hoshina K. Phlegmasia cerulea dolens as an initial manifestation of a fistula between a ruptured iliac artery aneurysm and the iliac vein. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:41-44. [PMID: 30734007 PMCID: PMC6355442 DOI: 10.1016/j.jvscit.2018.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/05/2018] [Indexed: 11/22/2022]
Abstract
Phlegmasia cerulea dolens (PCD) is caused by obstruction of limb venous return that may result in venous gangrene and limb loss. We present a case of a fistula between a ruptured right common iliac artery aneurysm and the left common iliac vein (ilioiliac arteriovenous fistula [AVF]), which initially manifested as left PCD and acute renal failure. Resection of the aneurysm and repair of the AVF immediately improved the PCD and acute renal failure. We should be aware that an iliac AVF might present as PCD and should keep this in mind.
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Affiliation(s)
| | - Kota Yamamoto
- Correspondence: Kota Yamamoto, MD, PhD, Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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24
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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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25
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Shatila W, Krajcer Z. Use of an AFX aortic cuff in the endovascular treatment of aortocaval fistula secondary to abdominal aortic pseudoaneurysm. Catheter Cardiovasc Interv 2018; 92:1352-1355. [PMID: 30260090 DOI: 10.1002/ccd.27830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 05/25/2018] [Accepted: 07/23/2018] [Indexed: 11/10/2022]
Abstract
Aortocaval fistula (ACF) is rare and lethal and can be either primary (due to an enlarged abdominal aortic aneurysm) or secondary (iatrogenic or secondary to abdominal surgery) in origin. We describe a case of an ACF secondary to a ruptured abdominal aortic pseudoaneurysm that we successfully treated with a planned endovascular approach using an AFX aortic cuff on both the arterial and venous sides.
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Affiliation(s)
- Wassim Shatila
- Department of Cardiology, Texas Heart Institute, 6770 Bertner Avenue, Houston, Texas.,Department of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas.,Division of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, Texas
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, 6770 Bertner Avenue, Houston, Texas.,Department of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas.,Division of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, Texas
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26
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Patelis N, Giagkos GC, Maltezos K, Klonaris C. Aortocaval fistula: an unusual complication of ruptured abdominal aortic aneurysm. BMJ Case Rep 2018; 2018:bcr-2018-224998. [PMID: 30021737 DOI: 10.1136/bcr-2018-224998] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm, which erodes into the wall of the inferior vena cava, resulting in the formation of a fistula. ACF presents with various inconsistent symptoms and signs. ACF can be a diagnostic dilemma if not suspected and it is lethal if left untreated.A 60-year-old man presented with abdominal and lower back pain of sudden onset. Renal and liver functions were impaired, without signs of cardiac failure. CT angiography revealed an abdominal aneurysm rupture into the inferior vena cava. Patient underwent a successful open repair: ACF ligation from within the aneurysmal sac and an aorto-bi-iliac bypass using a Dacron graft. Renal and liver functions improved and the patient was discharged on the eighth postoperative day. A month later, the patient was fit and well with normal liver and renal functions.Despite progress made in the endovascular treatment of ACF, complications still persist with a reported endoleak rate of 50%. Open repair is still a valid method for ACF repair in patients fit to undergo laparotomy and general anaesthesia. In this case, the patient was fit and along the lack of a suitable stent graft, the vascular team performed an open repair with good results.Open repair of an ACF is a valid treatment method for patients who are fit enough to undergo laparotomy and general anaesthesia, and avoids complications related to endovascular repair, such as endoleaks.
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Affiliation(s)
- Nikolaos Patelis
- First Department of Surgery, Vascular Unit, Laikon Hospital, Athens, Greece
| | | | | | - Chris Klonaris
- First Department of Surgery, Vascular Unit, Laikon Hospital, Athens, Greece
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27
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Wang Y, Yu W, Li Y, Wang H. Emergent Endovascular Repair of Challenging Aortocaval Fistula With Hostile Anatomy. Vasc Endovascular Surg 2017; 51:255-260. [PMID: 28486843 DOI: 10.1177/1538574417701323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aortocaval fistula (ACF) is a rare complication. Endovascular repair is an option for this fatal condition. However, endoleak and persistent fistula may occur and lead to technical failure. We performed endovascular repair for 3 cases of challenging ACF with hostile anatomy. Patient 1 was an 80-year-old man who complained of abdominal distension and lower limb edema for 15 days. He had renal and cardiac dysfunction. Computed tomography angiography (CTA) showed an ACF and extreme tortuosity of right iliac artery. The super-stiff guidewire could not pass the right iliac artery. We performed endovascular repair and an occluder was used to block the right external iliac artery. Postoperative CTA showed migration of the occluder, and we ligated the right external iliac artery. The patient survived for 5 years. Patient 2 was a 78-year-old man who complained of an acute abdominal pain for 30 hours. Computed tomography angiography showed great neck angulation (63.3°) and a huge aneurysm (9.9 cm in diameter). A type 1A endoleak occurred and an aortic cuff was deployed at the proximal seal zone. Meanwhile, a type 3 endoleak occurred because of the migration and detachment of the left iliac limb. Another stent-graft was deployed to connect the iliac limb. The patient was followed up for 1 year and remained in a good condition. Patient 3 was a 74-year-old man who experienced severe abdominal pain for 1 day. Computed tomography angiography showed great neck angulation (66°) and a huge aneurysm (10.1 cm in diameter). A type 1A endoleak occurred, and an aortic cuff was deployed at the proximal seal zone. The patient was followed up for 6 months. In conclusion, ACF is a rare but a fatal condition. Acute cases and chronic cases with instable hemodynamics need urgent diagnosis and surgical intervention. Endovascular repair is an efficacious alternative to the traditional open repair.
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Affiliation(s)
- Yuewei Wang
- 1 Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenjuan Yu
- 2 Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yongxin Li
- 1 Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haofu Wang
- 1 Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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28
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Blumberg SN, Mussa FF, Maldonado TS. Percutaneous fenestrated endovascular aortic graft treatment of aortocaval fistula with aortic pseudoaneurysms secondary to penetrating trauma. J Vasc Surg 2017; 66:906-909. [PMID: 28366308 DOI: 10.1016/j.jvs.2016.12.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 12/27/2016] [Indexed: 11/28/2022]
Abstract
Aortocaval fistula (ACF) is a lethal complication of aortic aneurysmal disease. Traditional treatment of ACF involves open surgical approaches to fistula ligation and repair of the great vessels, with a high mortality secondary to bleeding and cardiac compromise. We present the case of a 28-year-old man with a chronic ACF with concomitant aortic pseudoaneurysms secondary to penetrating trauma treated with a fenestrated endograft.
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Affiliation(s)
- Sheila N Blumberg
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
| | - Firas F Mussa
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Thomas S Maldonado
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
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29
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Endovascular Management of Para-prosthetic Aortocaval Fistula: Case Report and Systematic Review of the Literature. Ann Vasc Surg 2017; 40:300.e1-300.e9. [PMID: 28163172 DOI: 10.1016/j.avsg.2016.08.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 11/23/2022]
Abstract
The aim of this article is to report a case of asymptomatic para-anastomotic aortocaval fistula (ACF) treated by endovascular aortic repair, and to review data of the literature on arteriovenous fistulae secondary to abdominal aortic surgery. A 78-year-old male complained of worsening pain in the right lower limb since 2 months. He presented a history of right femoropopliteal bypass for peripheral arterial occlusive disease and elective surgical treatment for a non-ruptured infrarenal aortic aneurysm (Dacron tube graft). Duplex ultrasound revealed an occlusion of the right common femoral artery and bypass graft. The digital subtraction angiography confirmed these findings and showed progression of the contrast medium from the aorta to the inferior vena cava at aortic carrefour level, suggestive of ACF. An abdomen/pelvis computed tomography angiogram (CTA) confirmed the arteriovenous communication at distal anastomosis of the aortoaortic Dacron graft. An urgent endovascular placement of AFX™ (Endologix, Inc., Irvine, CA) aorto-biiliac stent graft was performed, associated with endarterectomy of the right common and deep femoral artery. The postoperative course was regular without complications. The 5-day and 1-month CTA showed complete exclusion of the ACF. A systematic review of the literature was also performed regarding ACF secondary to aortic surgery.
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30
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Ben Abdallah I, El Batti S, da Costa JB, Julia P, Alsac JM. Phlegmasia Cerulea Dolens as an Unusual Presentation of Ruptured Abdominal Aortic Aneurysm into the Inferior Vena Cava. Ann Vasc Surg 2016; 40:298.e1-298.e4. [PMID: 27939371 DOI: 10.1016/j.avsg.2016.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
The aim of this case study is to report a case of unusual manifestation of ruptured abdominal aortic aneurysm (AAA) involving an aortocaval fistula (ACF) as phlegmasia cerulea dolens (PCD). A 58-year-old male presented with acute signs of PCD of the right lower limb, confirmed on duplex ultrasonography. Computed tomography angiography revealed a 65-mm ruptured AAA with a large ACF. Successful emergent surgical repair was performed, using implantation of an aortobi-iliac graft with primary closure of the fistula and associated venous thrombectomy. PCD revealing a ruptured AAA with ACF is rare. Knowledge of this original entity might be the most important factor on the outcome.
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Affiliation(s)
- Iannis Ben Abdallah
- Service de Chirurgie Cardiaque et Vasculaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
| | - Salma El Batti
- Service de Chirurgie Cardiaque et Vasculaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Faculté de Médecine, Université Paris-Descartes, Paris, France
| | - José Batista da Costa
- Service de Chirurgie Cardiaque et Vasculaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Pierre Julia
- Service de Chirurgie Cardiaque et Vasculaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Faculté de Médecine, Université Paris-Descartes, Paris, France
| | - Jean-Marc Alsac
- Service de Chirurgie Cardiaque et Vasculaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Faculté de Médecine, Université Paris-Descartes, Paris, France
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