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Gijsels S, Croo A, Randon C. Spontaneous Ilio-Iliac Arteriovenous Fistula from Rupture of an Iliac Aneurysm: A Systematic Review. Ann Vasc Surg 2024; 104:110-123. [PMID: 37931802 DOI: 10.1016/j.avsg.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Spontaneous arteriovenous fistulas (AVF) caused by iliac aneurysms are a rare condition with possible dramatic complications due to secondary hemodynamic changes. Diagnosis can be challenging because patients may present with progressive cardiac failure or even hemodynamic shock as primary symptom. Due to the rarity of the condition, data are scarce and treatment decisions are challenging. The aim of this systematic review is to give an overview of the symptoms, treatment possibilities, and patient outcomes. METHODS Literature searches were performed in PubMed, Embase, Web of Science, and Scopus. Case reports and literature reviews were included in the review. The literature review was performed by 2 independent reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A third reviewer was available in case of disagreement. The study was registered in Prospero (ID CRD42022335318). All cases of isolated, iliac atherosclerotic aneurysms with spontaneous fistulization into an iliac vein were included. RESULTS Fifty articles were included, resulting in 62 cases. A case from our own center was included, bringing the total up to 63 cases. Median age was 71 years, ranging from 41 to 87 years. 87.3% of patients were male, 6.3% were female, and in 6.3% sex was not reported. The duration of symptoms until presentation ranged from less than an hour to 6 years. 73.0% was treated with open surgery and 17.5% was treated by endovascular way, with 4 reinterventions in the endovascular group. There was an overall mortality rate of 9.5%. CONCLUSIONS Although rare, iliac AVF might cause acute therapy-resistant heart failure and hemodynamic instability. In patients with acute heart failure, especially when combined with a pulsating mass with accompanying bruit or thrill and unilateral swollen leg, an AVF should be suspected. Surgical treatment of AVF has an excellent outcome, provided that the condition had been diagnosed preoperatively.
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Affiliation(s)
- Stefanie Gijsels
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Alexander Croo
- Department of Thoracic and Vascular surgery, General Municipal Hospital, Aalst, Belgium
| | - Caren Randon
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
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Lim ET, Khanafer A. An open approach to a ruptured common iliac artery aneurysm with resultant ilio-iliac arteriovenous fistula. Vascular 2024; 32:25-27. [PMID: 36053668 DOI: 10.1177/17085381221124703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Presentations of a spontaneous ilio-iliac arteriovenous fistula are considered a rare occurrence and warrant urgent intervention. They are usually a result following trauma, previous surgery or uncommonly from a ruptured aneurysm. METHOD We describe a case of a patient presenting with general malaise who examined to have a pulsatile abdominal mass with an associated bruit. He was found to have an ilio-iliac arteriovenous fistula secondary to a ruptured iliac aneurysm that was treated successfully with open surgical repair. RESULT The patient was brought forward for open surgical repair due to haemodynamic instability as well as likely predicted difficulties with endovascular repair. Intra-operatively, his sigmoid colon was adherent to the aneurysm prompting the need for a Hartmann's procedure to allow for better visualisation of the aneurysm. A combination of external digital compression and Prolene suture was used to close the arteriovenous fistula. CONCLUSION Open surgical repair of an ilio-iliac arteriovenous fistula secondary to a ruptured iliac aneurysm appears to be safe and feasible approach. The advancement of medical technology does open up the possibility of an endovascular approach; however, in a small subset of patients, open repair would appear to be better.
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Affiliation(s)
- Eric Ta Lim
- Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, New Zealand
| | - Adib Khanafer
- Department of Vascular, Endovascular and Transplant Surgery, Christchurch Hospital, New Zealand
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Proczka R, Waliszewski M, Proczka M, Mazur S. Endovascular Repair of an Iliac Arteriovenous Fistula in a 30-Year-Old Female Patient with Suspected Severe Cardiac Insufficiency: A Case Report. Cardiol Ther 2022; 11:309-317. [PMID: 35553021 PMCID: PMC9135917 DOI: 10.1007/s40119-022-00264-8] [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: 02/25/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
A 30-year-old female was initially diagnosed with cardiac insufficiency and severe claudication. Additional imaging revealed a large iliac arteriovenous fistula, which was treated with an endovascular technique. A custom-made, self-expanding, polytetrafluorethylene-covered stent was implanted to restore the physiologic hemodynamic environment. The patient was asymptomatic at the 12-month clinical follow-up.
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Affiliation(s)
- R Proczka
- Szpital Medicover, Al. Rzeczypospolitej 5, 02-972, Warsaw, Poland.
| | - M Waliszewski
- Medical Scientific Affairs, B. Braun Melsungen AG, Berlin, Germany.,Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
| | - M Proczka
- Szpital Medicover, Al. Rzeczypospolitej 5, 02-972, Warsaw, Poland.,Medical University of Warsaw, Warsaw, Poland
| | - S Mazur
- Szpital Medicover, Al. Rzeczypospolitej 5, 02-972, Warsaw, Poland
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Yoo YS. Endovascular repair of an ilio-iliac arteriovenous fistula following rupture of common iliac artery aneurysm with an aortic extension cuff in common iliac vein: A case report. Medicine (Baltimore) 2022; 101:e28548. [PMID: 35029215 PMCID: PMC8757959 DOI: 10.1097/md.0000000000028548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/22/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Common iliac artery aneurysm (CIAA) is complicated by ilio-iliac arteriovenous fistulas (IIAVF), which is rare but fatal and require prompt diagnosis and appropriate treatment. As open repair is associated with high morbidity and mortality, endovascular therapy is considered appropriate for treating an IIAVF. PATIENT CONCERNS A 76-year-old male patient who developed an IIAVF as a complication of ruptured CIAA, requiring immediate surgical repair presented to the hospital with hemodynamic instability. DIAGNOSIS Computed tomography angiography and conventional angiography revealed an IIAVF. INTERVENTION Endovascular therapy was selected to reduce the risk of morbidity and mortality. As the angiogram after the first endovascular aneurysm repair with stent-grafting showed contrast medium filling in the aneurysm sac, right common iliac vein, and the inferior vena cava, an aortic extension cuff was inserted into the right common iliac vein to close the orifice on the venous side. OUTCOMES The right lower leg edema and discomfort were resolved immediately after the procedure, with the vital signs remaining stable. Computed tomography performed 6 months postoperatively showed patent stent-grafts of the artery and vein, with no evidence of IIAVF and endoleak. LESSONS IIAVF following CIAA rupture can be repaired successfully by stenting of the common iliac vein with an aortic extension cuff. For successful endovascular repair, the vein side of the fistula tract should be excluded with a stent-graft to block the backflow into the aneurysm sac.
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Affiliation(s)
- Young Sun Yoo
- Department of Surgery, College of Medicine, Chosun University, Gwangju, South Korea
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Speranza G, Pezold M, Jacobowitz G, Garg K. Hepatorenal syndrome from an ilio-iliac arteriovenous fistula: A rare complication from an endoleak. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:654-658. [PMID: 34693097 PMCID: PMC8515083 DOI: 10.1016/j.jvscit.2021.04.003] [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: 08/30/2020] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
Arteriovenous fistula is a rare and often unrecognized complication of aneurysms, with a varied and frequently inconsistent presentation. We present the case of an ilio-iliac arteriovenous fistula formation in a 71-year-old man associated with a type III endoleak after endovascular iliac branch repair. Because of rapidly progressing congestive heart failure and hepatorenal syndrome, we performed urgent endovascular repair with successful endoleak exclusion. After the procedure, the patient demonstrated a remarkably rapid and complete recovery.
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Affiliation(s)
| | - Michael Pezold
- Division of Vascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
| | - Glenn Jacobowitz
- Division of Vascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
| | - Karan Garg
- Division of Vascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
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Piljic D, Hajdarevic A, Piljic D, Behrem A, Petricevic M, Samoukovic G. A Giant Internal Iliac Artery Aneurysm with Arteriovenous Fistulization. Curr Med Imaging 2021; 17:660-661. [PMID: 33213327 DOI: 10.2174/1573405616666201118114712] [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: 04/26/2020] [Revised: 09/16/2020] [Accepted: 10/14/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Isolated iliac artery aneurysms are rare and occur predominantly in men at an older age. Such aneurysms can rupture into an adjacent organ (such as the bowel, bladder or ureter) or into the adjacent common iliac vein, resulting in an arteriovenous fistula. INTRODUCTION Formation of an internal iliac arteriovenous fistula caused by spontaneous rupture of an atherosclerotic iliac artery aneurysm wall is an exceedingly rare yet serious complication. CASE PRESENTATION This article presents a case of an internal iliac arteriovenous fistula caused by rupture of an atherosclerotic giant iliac artery aneurysm. CONCLUSION Rapid diagnosis and meticulous surgical technique improve outcomes in patients with this rare vascular complication.
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Affiliation(s)
- Dragan Piljic
- Cardiovascular Surgery Clinic, University Clinical Center, Tuzla, Bosnia and Herzegovina
| | - Alen Hajdarevic
- Cardiovascular Surgery Clinic, University Clinical Center, Tuzla, Bosnia and Herzegovina
| | - Dilista Piljic
- Cardiovascular Surgery Clinic, University Clinical Center, Tuzla, Bosnia and Herzegovina
| | - Adnan Behrem
- Cardiovascular Surgery Clinic, University Clinical Center, Tuzla, Bosnia and Herzegovina
| | - Mate Petricevic
- Department of Cardiac Surgery, University Hospital Centre, Zagreb, Croatia
| | - Gordan Samoukovic
- Department of Surgery, Divisions of Cardiac Surgery and Critical Care, McGill University Health Centre, Montreal, Canada
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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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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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Sivakumaran Y, Khashram M, Haggart PC. An Ilio-iliac Arteriovenous Fistula Following Spontaneous Rupture of a Right Common Iliac Artery Aneurysm. VASCULAR AND ENDOVASCULAR REVIEW 2018. [DOI: 10.15420/ver.2018.4.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The formation of an ilio-iliac arteriovenous fistula is a potentially lethal complication of common iliac artery aneurysm presentations. Whilst trauma predominantly accounts for the majority, spontaneous rupture of a common iliac artery aneurysm into an adjacent venous structure accounts for a small subset of patients. Urgent surgical intervention is warranted with the aim to restore arterial continuity and ideally, closure of the fistula. This case study describes the endovascular management of a spontaneous ilio-iliac arteriovenous fistula following rupture of a common iliac artery aneurysm into an adjacent vein.
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Affiliation(s)
- Yogeesan Sivakumaran
- Department of Vascular Surgery, Waikato District Health Board, Hamilton, New Zealand
| | - Manar Khashram
- Department of Vascular Surgery, Waikato District Health Board, Hamilton, New Zealand
| | - Paul Charles Haggart
- Department of Vascular Surgery, Waikato District Health Board, Hamilton, New Zealand
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Hachiro K, Kinoshita T, Suzuki T, Asai T. Surgical Repair of an Arteriovenous Fistula in the Posterior Wall of the Right Common Iliac Vein. Ann Vasc Dis 2018; 11:127-129. [PMID: 29682120 PMCID: PMC5882342 DOI: 10.3400/avd.cr.17-00092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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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Affiliation(s)
- Kohei Hachiro
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takeshi Kinoshita
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tomoaki Suzuki
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tohru Asai
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
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Rehman S, Sinclair H, Rodway A, Kovalic A, Webb-Peploe K, Yusuf SW. Same features, different diagnosis: A case of ilio-iliac arteriovenous fistula presenting as decompensated heart failure. JRSM Open 2017; 8:2054270417739778. [PMID: 29163978 PMCID: PMC5682584 DOI: 10.1177/2054270417739778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In case of high output cardiac failure, an arteriovenous fistula should be considered.
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Affiliation(s)
- Saad Rehman
- Brighton and Sussex University Hospital NHS Foundation Trust, Brighton BN2 5BE, UK
| | - Hamish Sinclair
- Brighton and Sussex University Hospital NHS Foundation Trust, Brighton BN2 5BE, UK
| | - Alex Rodway
- Brighton and Sussex University Hospital NHS Foundation Trust, Brighton BN2 5BE, UK
| | - Alex Kovalic
- Brighton and Sussex University Hospital NHS Foundation Trust, Brighton BN2 5BE, UK
| | | | - Syed Waquar Yusuf
- Brighton and Sussex University Hospital NHS Foundation Trust, Brighton BN2 5BE, UK
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Doi S, Motoyama Y, Ito H. Blood pressure shifts resulting from a concealed arteriovenous fistula associated with an iliac aneurysm: a case report. JA Clin Rep 2016; 2:33. [PMID: 29492428 PMCID: PMC5814788 DOI: 10.1186/s40981-016-0057-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/11/2016] [Indexed: 11/23/2022] Open
Abstract
Background A solitary iliac aneurysm (SIA) is more uncommon than an abdominal aortic aneurysm. The aneurysm is located in the deep pelvis and is diagnosed when it reaches a large size with symptoms of compression around adjacent structures and organs or when it ruptures. A definite diagnosis of an arteriovenous fistula (AVF) associated with a SIA is difficult preoperatively because there might not be enough symptoms and time for diagnosis. Here, we present a patient with asymptomatic rupture of SIA into the common iliac vein with characteristic blood pressure shifts. Case presentation A 41-year-old man with a huge SIA underwent aortobifemoral graft replacement. Preoperatively, his blood pressure showed characteristic shifts for one or two heartbeats out of five beats, indicating that an AVF was present and that the shunt was about to having a high flow. During surgery, an AVF associated with the SIA was found to be concealed owing to compression from the huge iliac artery aneurysm, and the shunt showed a high flow, resulting in shock during the surgery. No complications were noted after aortobifemoral graft replacement. Postoperatively, we noted an enhanced paravertebral vein on computed tomography (CT), which indicated the presence of an AVF. Conclusions Definite diagnosis of an AVF offers advantages in surgical and anesthetic management. We emphasize that a large SIA can push the iliac vein and occlude an AVF laceration, concealing the enhancement of the veins in the arterial phase on CT. Blood pressure shifts might predict the existence of a concealed AVF that has a large shunt. Even if the vena cava and the iliac veins are not enhanced on CT, anesthesiologists should carefully determine whether their distal branches are enhanced.
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Affiliation(s)
- Shintaro Doi
- Department of Anesthesiology, Sanai Hospital, 4-35-17 Tajima, Sakura-ku, Saitama City, Saitama 338-0837 Japan
| | | | - Hiromi Ito
- Department of Anesthesiology, Tobu Chiiki Hospital, Tokyo, Japan
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