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Dakis K, Nana P, Kouvelos G, Behrendt CA, Kölbel T, Giannoukas A, Spanos K. Treatment of Aortocaval Fistula Secondary to Abdominal Aortic Aneurysm: A Systematic Review. Ann Vasc Surg 2023; 90:204-217. [PMID: 36496094 DOI: 10.1016/j.avsg.2022.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Aortocaval fistula (ACF) secondary to an abdominal aortic aneurysm is a rare complication, inadvertently caused by a rupture into the inferior vena cava. Different treatment modalities have been applied toward the repair of such lesions, including open surgical and endovascular repair. The aim of this study was to report on ACF treatment and to analyze its early and mid-term outcomes. METHODS A systematic search of the English medical literature published between 2000 and 2022 was undertaken, using PubMed, SCOPUS, and CENTRAL databases as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. A study protocol was registered in PROSPERO (CRD42022329058). Studies reporting on primary ACF outcomes following open surgical or endovascular repair were included. The ROBINS-I tool was applied for risk of bias assessment. Outcomes included technical success, 30-day and mid-term survival, endoleak following endovascular repair, and reintervention rates. RESULTS In total, 110 case studies, incorporating 196 patients (mean age; 66.2 years, males 96%) were included. Open surgical repair was applied in 78% (153/196). From the available data, technical success rate for each modality was 99% (152/153) and 100% (43/43), respectively. Open and endovascular repair demonstrated 87.5% (126/144) and 97.6% (42/43) 30-day survival, respectively, while mid-term survival was 86% (74/86) and 95.2% (20/21), respectively (medial follow-up: 14 months [1-54 months]). Endoleaks were reported in 19 endovascular cases (39.5%). Type II endoleak was the most frequent with a rate at 32.5% (14/43). Reintervention rates were 2.5% (4/151) and 35.7% (15/42) for open and endovascular repair, respectively. CONCLUSIONS Only few case studies were published on the treatment of this rare condition, while almost all invasive procedures were performed in males. Management of ACF repair with both open and endovascular approach was associated with excellent technical success rate and acceptable early and mid-term survival outcomes. Reintervention remained an issue for patients who were managed endovascularly.
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Affiliation(s)
- Konstantinos Dakis
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
| | - Petroula Nana
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - George Kouvelos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Christian-Alexander Behrendt
- German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Athanasios Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Spanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, Hamburg, Germany
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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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Kumar S, Mogalapalli A, Milunski MR. Chronic Aortocaval Fistula Presenting as Right Heart Failure: A Case Report and Review of Literature. Cureus 2021; 13:e13528. [PMID: 33786235 PMCID: PMC7995405 DOI: 10.7759/cureus.13528] [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: 12/20/2022] Open
Abstract
Iatrogenic aortocaval fistula (ACF) is an infrequent cause of heart failure. A 65-year-old man presented to the cardiology clinic eight months after an open abdominal aortic aneurysm (AAA) repair. He developed predominantly right-sided cardiac failure after surgery, with minimal response to guideline-directed medical therapy. A transthoracic echocardiogram revealed decreased right-sided systolic function. A computed tomography angiographic scan of the abdomen revealed a large ACF at the distal end of the AAA repair. The patient was referred for closure surgery. ACF should be considered in a patient with unexplained right heart failure, especially in the setting of a known AAA or recent AAA repair.
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Affiliation(s)
- Sundeep Kumar
- Cardiovascular Disease, Saint Louis University Hospital, St. Louis, USA.,Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Akhil Mogalapalli
- Internal Medicine, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, USA
| | - Mark R Milunski
- Cardiology, Orlando Veterans Affairs Medical Center, Orlando, USA
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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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5
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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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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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Bridging stent repair of type III endoleak causing aortocaval fistula after branched aortic endovascular repair. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 3:4-6. [PMID: 29349362 PMCID: PMC5757760 DOI: 10.1016/j.jvscit.2016.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 09/01/2016] [Indexed: 12/02/2022]
Abstract
A 62-year-old man presented to our department with abdominal pain and diarrhea for 3 weeks on a background of previous branched endovascular repair for a thoracoabdominal aneurysm. A triple-phase computed tomography scan of his abdomen and pelvis showed a large aortocaval fistula caused by a type III endoleak from a dislodged superior mesenteric artery stent. He was successfully treated with a BeGraft (Bentley Innomed, Hechingen, Germany) by using an endovascular technique.
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8
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Zhou W, Bush RL, Terramani TT, Lin PH, Lumsden AB. Treatment Options of Iatrogenic Pelvic Vein Injuries: Conventional Operative Versus Endovascular Approach. Vasc Endovascular Surg 2016; 38:569-73. [PMID: 15592639 DOI: 10.1177/153857440403800612] [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: 11/17/2022]
Abstract
Iatrogenic injury to the iliac vein or inferior vena cava (IVC), which may occur during abdominal operations or posterior orthopedic procedures, can have devastating consequences. Operative management is challenging and may be associated with significant morbidity. The authors report herein 3 cases of iatrogenic pelvic vein injuries that were managed with different treatment approaches. Both traditional open surgical therapy and endovascular techniques are described.
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Affiliation(s)
- Wei Zhou
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
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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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10
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Orion KC, Beaulieu RJ, Black JH. Aortocaval Fistula: Is Endovascular Repair the Preferred Solution? Ann Vasc Surg 2016; 31:221-8. [PMID: 26597238 PMCID: PMC4860718 DOI: 10.1016/j.avsg.2015.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/26/2015] [Accepted: 09/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND To compare outcomes of open and endovascular repair of aortocaval fistulas (ACFs) in the setting of abdominal aortic aneurysms (AAAs). METHODS A literature review was undertaken on Pubmed from 1999 to 2014 to identify reported cases of both endovascular and open repair of ACF, including the index case, presented here. Primary outcomes for endovascular repair were: complications, presence of endoleak, and death. Primary outcomes for open repair were: complications and death. RESULTS Forty articles were reviewed with a total of 67 patients, including the index case. Endovascular approach was used in 26 patients (39%). Endoleaks were present in 50%, whereas similarly 46% of patients had a reported complication. Five deaths (19%) occurred in the endovascular group. Open repair was performed in 41 cases (61%). The rate of complication and the death in open repair were 36% and 12%, respectively (P = 0.327 and P = 0.910, respectively) compared with endovascular. Mean follow-up was 7.7 months for the endovascular group and 8.5 months in the open group. CONCLUSIONS Previous demonstrations of high morbidity and mortality with open repair of ACF in the setting of AAA have motivated endovascular approaches. However, endoleaks are a significant problem and were present in 50% of ACF cases. The continued presence of an endoleak in the setting of an ACF may result in persistence of the ACF, unlikely thrombosis of the endoleak, and continued sac enlargement. Endovascular repair presents theoretical benefit, yet is not associated with a reduced rate of complication or death versus open repair in this contemporary review.
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Affiliation(s)
| | - Robert J Beaulieu
- Department of General Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - James H Black
- Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, Baltimore, MD.
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11
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Iijima M, Kawasaki M, Ishibashi Y. Successful surgical repair of an ilio-iliac arteriovenous fistula associated with a ruptured common iliac artery aneurysm. Int J Surg Case Rep 2015; 13:55-7. [PMID: 26117446 PMCID: PMC4529642 DOI: 10.1016/j.ijscr.2015.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/28/2015] [Accepted: 06/09/2015] [Indexed: 11/30/2022] Open
Abstract
We report the successful surgical treatment of an ilio-iliac arteriovenous fistula. Although rare, this disease can be life-threatening. Use of multiple imaging modalities facilitates correct preoperative diagnosis. Balloon occlusion technique is used to minimize blood loss during open repair. There was no sign of high-output heart failure because of venous flow failure.
Introduction We describe the case of an 86-year-old man with an ilio-iliac arteriovenous fistula (AVF) resulting from a ruptured aneurysm. This condition rarely occurs, has a high mortality rate, and was successfully treated via surgery. Presentation of case The patient presented with a temporary loss of consciousness and left leg edema. A pulsatile abdominal mass with vascular murmur and thrill was detected. Enhanced computed tomography showed abdominal aortic and iliac aneurysms with left common iliac vein occlusion, and the left external iliac vein was easily seen through the AVF. We directly sutured the AVF and performed aneurysmectomy and prosthetic graft replacement. During surgery, placement of occlusive balloon catheters through the AVF minimized intraoperative bleeding. The patient recovered uneventfully, and swelling of the left leg was immediately reduced after surgery. Discussion Although rare, AVFs can be life-threatening, and urgent treatment and intensive care are occasionally needed. Surgical management of AVF requires a definitive preoperative diagnosis and control of venous bleeding during surgery. Fulfilling these major requirements can potentially reduce morbidity and mortality in patients with AVFs. Interestingly, there was no sign of high-output heart failure throughout the treatment course due to compression of the aneurysm and consequent blood flow failure to the left iliac vein. Conclusion Using the balloon occlusion technique, we were able to minimize blood loss during open repair. Use of multiple imaging modalities facilitates correct preoperative diagnosis and consequently improves surgical outcome.
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Affiliation(s)
- Makoto Iijima
- Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany.
| | - Masakazu Kawasaki
- Division of Cardiovascular Surgery, National Hospital Organization, Hokkaido Medical Center, Sapporo, Hokkaido, Japan.
| | - Yoshimitsu Ishibashi
- Division of Cardiovascular Surgery, National Hospital Organization, Hokkaido Medical Center, Sapporo, Hokkaido, Japan.
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Xu L, Wu Z, Qu L, Burchell S. Endovascular occlusion of primary major pelvic arteriovenous fistula using patent ductus arteriosus occluder. Perfusion 2015; 31:172-5. [PMID: 25918040 DOI: 10.1177/0267659115585136] [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
The aim of the present study was to investigate the effects and safety of a patent ductus arteriosus occluder (PDAO) in the management of major abdominal arteriovenous fistula. A 56-year-old man was admitted into our hospital, presenting with impeded defecation and claudication. Computed tomographic angiography (CTA) was conducted upon admission, which revealed an aneurysm-like lesion, with the left internal iliac artery as its feeding artery. Super-selective embolization treatment was accomplished using a single PDAO. The results of the CTA at follow-up showed no recanalization of the lesion and that a PDAO was at the site. The patient had no pelvic ischemia complications.
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Affiliation(s)
- L Xu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Z Wu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - L Qu
- Department of Vascular and Endovascular Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - S Burchell
- Loma Linda University School of Medicine, Loma Linda, CA, USA
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Ueshima E, Yamaguchi M, Muradi A, Okada T, Idoguchi K, Sofue K, Nomura Y, Okita Y, Sugimoto K. Management of type II endoleak after endovascular repair of arteriocaval fistula complicating aortoiliac aneurysm: case report and literature review. J Vasc Interv Radiol 2014; 25:1809-15. [PMID: 25442141 DOI: 10.1016/j.jvir.2014.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/23/2014] [Accepted: 06/23/2014] [Indexed: 10/24/2022] Open
Abstract
Endovascular treatment for arteriocaval fistula (ACF) has become the preferred alternative to open repair. However, endoleaks sometimes occur and maintain the ACF. A 64-year-old man presented with persistent fistula after placement of a bifurcated stent-graft for ACF complicating an aortoiliac aneurysm that was maintained by endoleaks from the inferior mesenteric and lumbar arteries. Transarterial embolization of the aneurysm sac and inferior mesenteric artery successfully resolved the problem without any complications observed over 16 months of follow-up. A literature review and discussion of the management options for this entity are presented. A combination of inflow and outflow control is important to obtain better long-term outcomes.
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Affiliation(s)
- Eisuke Ueshima
- Center for Endovascular Therapy, Kobe University Hospital, Kobe, Japan; Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Masato Yamaguchi
- Center for Endovascular Therapy, Kobe University Hospital, Kobe, Japan; Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Akhmadu Muradi
- Center for Endovascular Therapy, Kobe University Hospital, Kobe, Japan
| | - Takuya Okada
- Center for Endovascular Therapy, Kobe University Hospital, Kobe, Japan; Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Koji Idoguchi
- Center for Endovascular Therapy, Kobe University Hospital, Kobe, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yoshikatsu Nomura
- Center for Endovascular Therapy, Kobe University Hospital, Kobe, Japan; Cardiovascular Division, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan; Vascular and Endovascular Division, Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
| | - Yutaka Okita
- Cardiovascular Division, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan; Vascular and Endovascular Division, Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
| | - Koji Sugimoto
- Center for Endovascular Therapy, Kobe University Hospital, Kobe, Japan; Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Abstract
Purpose: To review the different outcomes of the endovascular repair of major abdominal arteriovenous fistulas (AVFs). Methods: An online systematic review of the literature was undertaken to identify all reported cases of endovascular repair of major AVFs, covering 9 major databases as well as relevant journals up to September 2013. Our own case was included. The primary outcome was technical success and mortality, the secondary outcome was the rate of complications and the operators’ recommendations. Results: Forty-eight articles were reviewed totaling a number of 54 patients including our own. The most common fistula site was the aortocaval segment. Aortic stent grafts were used in 78% of patients. Technical success was 94%. Intraoperative mortality was 0% with a 90-day mortality of 10%, half of which were not related to the primary pathology. Of the successful procedures, 12% of patients had major complications. One died before reintervention. All others had uneventful recoveries; 21% had minor complications treated conservatively. The majority of authors were in favor of this treatment modality.
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Madani A, Leung S, Obrand D. Open repair of inflammatory abdominal aortic aneurysm and aortocaval fistula using retrograde balloon occlusion. Vasc Endovascular Surg 2013; 48:80-2. [PMID: 24142957 DOI: 10.1177/1538574413508828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this report is to describe a novel endovascular technique used to minimize blood loss during the open repair of an aortocaval fistula (ACF) in the context of an inflammatory abdominal aortic aneurysm (AAA). CASE REPORT We describe a patient who presented to our hospital with a symptomatic infrarenal AAA which was discovered intraoperatively to contain a large ACF. The patient underwent successful transperitoneal open repair of the AAA with balloon occlusion of the inferior vena cava to obtain distal control of the vessel. CONCLUSIONS Retrograde balloon occlusion of the inferior vena cava can be used to control hemorrhage during the open repair of an ACF, especially in the challenging setting of an inflammatory AAA.
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Affiliation(s)
- Amin Madani
- 1Division of General Surgery, McGill University Health Center, Montreal, Quebec, Canada
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16
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van de Luijtgaarden KM, Bastos Gonçalves F, Rouwet EV, Hendriks JM, ten Raa S, Verhagen HJ. Conservative management of persistent aortocaval fistula after endovascular aortic repair. J Vasc Surg 2013; 58:1080-3. [DOI: 10.1016/j.jvs.2012.10.138] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 10/10/2012] [Accepted: 10/14/2012] [Indexed: 10/27/2022]
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Janczak D, Chabowski M, Szydelko T, Garcarek J. Endovascular exclusion of a large spontaneous aortocaval fistula in a patient with a ruptured aortic aneurysm. Vascular 2013; 22:202-5. [DOI: 10.1177/1708538113478749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A primary aortocaval fistula (ACF) is present in less than 1% of all abdominal aortic aneurysms (AAA). The case of a 62-year-old patient with a ruptured AAA and ACF was reported. A stent-graft was implanted into the abdominal aorta. An inferior vena cava filter was inserted to prevent pulmonary embolism. The patient made a smooth recovery. The follow-up computed tomographic scan three months later did not reveal any evidence of endoleaks or that the fistula was still present. Hemodynamic changes with regard to transient acute liver impairment were discovered (renal and liver parameters were presented). Endovascular exclusion appears to be an effective option in the treatment of an aortocaval fistula in comparison to conventional open repair.
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Affiliation(s)
- Dariusz Janczak
- Surgery Department, 4th Military Teaching Hospital, 5 Weigla Street, 50-981 Wroclaw, Poland
- Department of Clinical Proceedings, Faculty of Health Science, Medical University Wroclaw, 50-367 Wroclaw, Poland
| | - Mariusz Chabowski
- Surgery Department, 4th Military Teaching Hospital, 5 Weigla Street, 50-981 Wroclaw, Poland
| | - Tomasz Szydelko
- Surgery Department, 4th Military Teaching Hospital, 5 Weigla Street, 50-981 Wroclaw, Poland
| | - Jerzy Garcarek
- Surgery Department, 4th Military Teaching Hospital, 5 Weigla Street, 50-981 Wroclaw, Poland
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Brightwell RE, Pegna V, Boyne N. Aortocaval fistula: current management strategies. ANZ J Surg 2012; 83:31-5. [PMID: 23072669 DOI: 10.1111/j.1445-2197.2012.06294.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND There has been a trend towards favouring endovascular repair for much acute aortic pathology. We undertook a review of the literature to determine if an endovascular approach could complement the traditional treatment of aortocaval fistula (ACF), a rare complication of abdominal aortic aneurysm. METHODS A literature search was undertaken on PubMed using appropriate search terms. Case series and reviews reporting presentation, diagnosis and operative management (open and endovascular techniques) of ACF were selected and discussed. RESULTS Open surgical treatment of ACF has an associated morbidity and mortality - mainly from excessive blood loss. Open repair mortality rates are reported around 30%, but some centres report far lower rates based on preoperative diagnosis of the ACF. These rates appear to be reduced when using endovascular repair in selected cases, with success rates of up to 96%. Reiteration of the importance of diagnosis of ACF preoperatively was the common denominator with both open and endovascular repair. CONCLUSIONS Endovascular exclusion appears to be an efficacious means of treating ACF and averting the significant blood loss commonly encountered in conventional repair of these lesions. However, some reviews have suggested equal success with open repair. There is limited available published literature on ACF management and outcome, and likely reporting bias attached to both open and endovascular results that are published. With a randomized controlled trial unlikely to occur, a prospective registry may provide better outcome data.
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Affiliation(s)
- Robert E Brightwell
- Department of Vascular Surgery, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.
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19
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Shah TR, Parikh P, Borkon M, Mocharla R, Lonier J, Rosenzweig BP, Mussa FF. Endovascular Repair of Contained Abdominal Aortic Aneurysm Rupture With Aortocaval Fistula Presenting With High-Output Heart Failure. Vasc Endovascular Surg 2012; 47:51-6. [DOI: 10.1177/1538574412462633] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortocava fistula is a rare condition ranging from 0.22% to 6% of all ruptured aortic aneurysms. Recognition and diagnosis of this entity can often be difficult and requires heightened clinical suspicion to ensure that prompt surgical management leads to a favorable outcome. We herein describe the diagnosis and the technical points of successful endovascular management of aortocaval fistula in the setting of a ruptured abdominal aortic aneurysm.
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Affiliation(s)
- Tejas R. Shah
- Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY, USA
| | - Parin Parikh
- Leon Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Matthew Borkon
- Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY, USA
| | - Robert Mocharla
- Leon Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Jacqueline Lonier
- Leon Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Barry P. Rosenzweig
- Leon Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Firas F. Mussa
- Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY, USA
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20
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Davidovic L, Dragas M, Cvetkovic S, Kostic D, Cinara I, Banzic I. Twenty years of experience in the treatment of spontaneous aorto-venous fistulas in a developing country. World J Surg 2011; 35:1829-34. [PMID: 21533647 DOI: 10.1007/s00268-011-1128-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND One of the rare forms of abdominal aortic aneurysm (AAA) rupture is the rupture into great abdominal veins such as the inferior vein cava (IVC), the iliac veins, or the left renal vein, with the formation of direct or indirect aorto-caval fistula (ACF). The purpose of the present study was to summarize 20 years of experience at a single referral center for vascular surgery in a developing country, and to discuss the clinical presentation, diagnosis, treatment options, and outcome of patients with spontaneous aorto-venous fistulas (AVF) caused by ruptured aortic aneurysms. MATERIALS AND METHODS Retrospective database review identified 50 patients treated in our institution for aorto-venous fistulas (AVF) caused by spontaneous AAA rupture in the 20 years 1991-2010. Pulsating abdominal mass and low back pain were the leading symptoms on admission in our patients. Signs of shock, congestive heart failure, or pelvic and lower extremity venous hypertension were present in 48%, 26%, and 75% of the patients, respectively. Diagnosis of AVF was based on physical examination, duplex ultrasonography, conventional angiography, or multislice computed tomography (MSCT). In 40% of the patients the presence of AVF has not been recognized before surgery. All patients were treated with open surgery. RESULTS After proximal and distal bleeding control the fistula was closed with direct suture (92%) or patch angioplasty (8%). Aortic reconstruction followed with tubular (22%) or bifurcated (78%) synthetic graft. Six (12%) patients died. The causes of death were excessive intraoperative blood loss, myocardial infarction, left colon gangrene and multiple organ failure. CONCLUSIONS Spontaneous AVFs caused by aneurysmal rupture are not uncommon, and they require prompt surgical or endovascular treatment. Routine use of multislice CT in patients with acute aortic syndrome is probably the best way to the correct diagnosis of aorto-venous fistulas and planning of the optimal treatment.
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Affiliation(s)
- Lazar Davidovic
- Clinic for Vascular Surgery, Clinical Centre of Serbia, 8, Koste Todorovica st., Belgrade, Serbia
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21
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Jeuriëns-van de Ven SA, Schouten van der Velden AP, Schultze Kool LJ, van der Vliet JA, Berger P. Persisting Iliaco-Caval Fistula After EVAR Maintained by a Type II Endoleak. Ann Vasc Surg 2011; 25:1142.e7-9. [DOI: 10.1016/j.avsg.2011.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 06/19/2011] [Accepted: 08/07/2011] [Indexed: 10/16/2022]
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22
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Akwei S, Altaf N, Tennant W, MacSweeney S, Braithwaite B. Emergency endovascular repair of aortocaval fistula--a single center experience. Vasc Endovascular Surg 2011; 45:442-6. [PMID: 21571773 DOI: 10.1177/1538574411407087] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To review the outcomes of patients undergoing emergency endovascular repair of aortocaval fistula (ACF) secondary to abdominal aortic aneurysm (AAA). CASE REPORT Four consecutive patients who underwent emergency endovascular repair of ACF associated with AAA in a tertiary institution between 2002 and 2009. Of the 4 patients, 3 had initially been misdiagnosed and managed for several days by other specialists for their symptoms prior to diagnosis of their ACF. Three patients died in the early postoperative period. The fourth patient made a satisfactory postoperative recovery but subsequently required further endovascular surgery to treat a persistent type 1 endoleak. CONCLUSIONS Our experience illustrates the importance of early diagnosis and management of ACF. Even in experienced hands, the management of spontaneous ACF associated with AAA is challenging. Endovascular surgery may still have a role in improving outcomes in these patients.
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23
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Pevec WC, Lee ES, Lamba R. Symptomatic, acute aortocaval fistula complicating an infrarenal aortic aneurysm. J Vasc Surg 2010; 51:475. [DOI: 10.1016/j.jvs.2009.03.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Revised: 03/16/2009] [Accepted: 03/27/2009] [Indexed: 10/20/2022]
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24
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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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25
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Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, Timaran CH, Upchurch GR, Veith FJ. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 2009; 50:S2-49. [PMID: 19786250 DOI: 10.1016/j.jvs.2009.07.002] [Citation(s) in RCA: 453] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 07/06/2009] [Accepted: 07/06/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Elliot L Chaikof
- Department of Surgery, Emory University, Atlanta, Ga 30322, USA.
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26
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Hii HP, Wu ZH, Yeh ML, Chen CC. Successful coil embolization of an unusual aorto-superior mesenteric vein fistula. J Vasc Surg 2009; 49:1310-2. [PMID: 19327940 DOI: 10.1016/j.jvs.2008.12.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 12/09/2008] [Accepted: 12/21/2008] [Indexed: 11/25/2022]
Abstract
The aortovenous fistulas are rare, most of them are aortocaval fistula. The non-caval communication of the fistula is sparse. Herein we report a 47-year-old female diagnosed as traumatic aorto-superior mesenteric vein (Ao-SMV) fistula. The abdominal pain, fullness, and frank bruit on abdominal auscultation suggested the diagnosis of an intra-abdominal arteriovenous fistula. The diagnosis of Ao-SMV was further confirmed by the computed tomography (CT) and aortography. The fistula was successfully treated with transcatheter coil embolization. This is the first case of Ao-SMV fistula. It provides an alternative option of treatment other than conventional surgery.
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Affiliation(s)
- Hiong-Ping Hii
- Department of Surgery, Chi-Mei Foundational Hospital, Yungkang City, Tainan County, Taiwan
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27
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Kwon SH, Oh JH, Park SJ, Park HC. Endovascular repair of a spontaneous right common iliac artery--inferior vena cava fistula due to infrarenal aortoiliac aneurysm. Vasc Endovascular Surg 2008; 42:279-83. [PMID: 18258725 DOI: 10.1177/1538574407312649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Most abdominal aortic aneurysms are asymptomatic, but 1% to 4% of cases present with a life-threatening complication. A spontaneous right common iliac artery-inferior vena cava fistula, a rare condition caused by infrarenal aortoiliac aneurysm, is reported. In this case, the condition was successfully managed with primary endovascular stent-graft treatment.
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Affiliation(s)
- Se Hwan Kwon
- Department of Diagnostic Radiology, Kyung Hee University Hospital, 1 Hoeki-dong, Dongdaemun-gu, Seoul, Korea
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28
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López-García D, González-Arranz M, García-Gimeno M, Rodríguez-Camarero S. Tratamiento endovascular de una fístula aortocava complicado con una endofuga tipo II. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)06008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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29
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Laxdal E, Søvik K, Pedersen G, Aune S. Inflammatory infrarenal aortic aneurysm with aortocaval fistula. Ann Vasc Surg 2007; 21:633-6. [PMID: 17823045 DOI: 10.1016/j.avsg.2007.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 03/15/2007] [Indexed: 02/02/2023]
Abstract
This is a report of an open repair of an inflammatory infrarenal aneurysm with a large rupture into the vena cava. Preoperative imaging with contrast-enhanced computed tomography revealed the presence of the fistula and was an important aid in pre- and perioperative planning.
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Affiliation(s)
- E Laxdal
- Department of Vascular Surgery, Haukeland University Hospital, Bergen, Norway.
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30
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Johnston DF, Drinkwater S, Backhouse C. A case of renal impairment and raised venous pressure. Br J Radiol 2007; 80:499-501. [PMID: 17684080 DOI: 10.1259/bjr/68392357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- D F Johnston
- Colchester General Hospital, 2 Parker Road, Colchester, Essex CO4 5BE, UK.
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31
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Pinto DM, Bez LG, Dias Júnior JO, Lopes CDS, Mandil A. Aneurisma ilíaco associado a fístula arteriovenosa. J Vasc Bras 2007. [DOI: 10.1590/s1677-54492007000300016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A ruptura dos aneurismas aorto-ilíacos para a veia ilíaca ou veia cava é uma complicação pouco comum. A hipertensão venosa leva a vários sinais e sintomas, o que dificulta o diagnóstico pré-operatório, tais como edema do membro inferior, dispnéia, hematúria, sinais de insuficiência renal ou cardíaca. Sopro abdominal é a chave do diagnóstico clínico, associado à massa pulsátil e dor abdominal. O reconhecimento da fístula arteriovenosa no pré-operatório é importante para o planejamento cirúrgico. Relatamos um caso de aneurisma da artéria ilíaca comum e interna direita associado a fístula para veia ilíaca comum, cursando, inicialmente, com edema do membro inferior direito e dispnéia, o que levou ao diagnóstico incorreto de trombose venosa profunda.
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32
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Kopp R, Weidenhagen R, Hoffmann R, Waggershauser T, Meimarakis G, Andrassy J, Clevert D, Czerner S, Jauch KW. Immediate Endovascular Treatment of an Aortoiliac Aneurysm Ruptured into the Inferior Vena Cava. Ann Vasc Surg 2006; 20:525-8. [PMID: 16732443 DOI: 10.1007/s10016-006-9061-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Revised: 07/12/2005] [Accepted: 02/27/2006] [Indexed: 05/09/2023]
Abstract
An aortocaval fistula is a severe complication of an aortoiliac aneurysm, usually associated with high perioperative morbidity and mortality during open operative repair. We describe the successful endovascular treatment of a symptomatic infrarenal aortic aneurysm ruptured into the inferior vena cava with secondary interventional coiling of a persistent type II endoleak because of retrograde perfusion of the inferior mesenteric artery. Endovascular exclusion of ruptured abdominal aneurysms seems to be a valuable treatment option for selected patients even with complicated vascular conditions like an aortocaval fistula.
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Affiliation(s)
- Reinhard Kopp
- Department of Surgery, Klinikum Grosshadern, University of Munich, Munich, Germany.
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33
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Spencer TA, Smyth SH, Wittich G, Hunter GC. Delayed presentation of traumatic aortocaval fistula: A report of two cases and a review of the associated compensatory hemodynamic and structural changes. J Vasc Surg 2006; 43:836-40. [PMID: 16616246 DOI: 10.1016/j.jvs.2005.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Accepted: 12/01/2005] [Indexed: 11/16/2022]
Abstract
Chronic aortocaval fistula (ACF) is a rare complication of gunshot wounds to the abdomen. Herein we report two cases of traumatic ACF: one asymptomatic and the other presenting with congestive heart failure (CHF) 20 and 30 years, respectively, after their initial injury. The recent onset of CHF, the presence of a continuous abdominal bruit, and, in the second patient, a history of penetrating trauma suggested the diagnosis of ACF. The diagnosis was confirmed by computed tomography scanning in both patients. Surgical repair of the ACF in the symptomatic patient resulted in resolution of the CHF and reversed the dilatation of the aorta and inferior vena cava. The asymptomatic patient was lost to follow-up. CHF in a young male patient with a history of penetrating abdominal trauma should alert the surgeon to this rare complication.
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Affiliation(s)
- Todd A Spencer
- Department of Surgery, The University of Texas Medical Branch, Galveston 77555-0541, USA
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34
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Hetzel G, Gabriel P, Rompel O, Ritter W, Raithel D. Aortocaval Fistula After Stent-Graft Repair. J Endovasc Ther 2006; 13:117-20. [PMID: 16445316 DOI: 10.1583/05-1558mr.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To report an aortocaval fistula after stent-graft repair and the feasibility of interventional treatment. CASE REPORT A 78-year-old man with a 61-mm infrarenal aortic aneurysm (AA) was treated successfully with a Zenith bifurcated stent-graft. Three years later, the patient presented with deteriorating renal function and acute bronchial obstruction. Computed tomography showed an aortic diameter increased to 90 mm, dilatation of the inferior vena cava, and a distal type I endoleak. The patient's condition quickly deteriorated, and emergent imaging found a fistula with brisk flow between the aneurysm sac and the left iliac vein within a distal type I endoleak. During emergency endovascular repair, iliac extensions were implanted in the right common iliac artery and left external iliac artery. The left hypogastric artery was coil embolized to exclude flow into the aneurysm sac. After positioning the extensions, cardiac function improved, and the fistula was no longer palpable. The cardiac indices and renal function normalized, and he was discharged 20 days after admission. CONCLUSION Aortocaval fistulas are a rare complication of AA stent-graft repair and may be successfully treated by interventional means.
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Affiliation(s)
- Gudrun Hetzel
- Department of Vascular and Endovascular Surgery, Klinikum Nürnberg, Germany.
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35
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Vetrhus M, McWilliams R, Tan CK, Brennan J, Gilling-Smith G, Harris PL. Endovascular repair of abdominal aortic aneurysms with aortocaval fistula. Eur J Vasc Endovasc Surg 2005; 30:640-3. [PMID: 16168683 DOI: 10.1016/j.ejvs.2005.07.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Accepted: 07/16/2005] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To examine the risk of high-flow type II endoleak following endovascular repair of abdominal aortic aneurysm with aortocaval fistula. DESIGN Case reports. SUBJECTS Two patients with abdominal aortic aneurysms with aortocaval fistula. METHODS Both patients had an endovascular repair of their aortic aneurysms. RESULTS The aneurysms were successfully treated in both patients, without any endoleak on completion angiography. Apart from a transient type II lumbar endoleak in one of the patients, no endoleak was found after 3 and 12 month follow-up. Seven other cases have been published, reporting one type II and one type Ic endoleak. CONCLUSION We found no evidence that endovascular repair of abdominal aortic aneurysm with aortocaval fistula is associated with a higher incidence of persistent endoleak.
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Affiliation(s)
- M Vetrhus
- Regional Vascular unit, Royal Liverpool, University Hospital, Liverpool, UK.
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36
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Ferrari M, Berchiolli R, Sardella SG, Cioni R, Petruzzi P, Del Corso A, Di Mitri R, Croce C, Romagnani F, Adami D, Mosca F. Endovascular Repair of an Aorto–Left Renal Vein Fistula Due to a Ruptured Abdominal Aortic Aneurysm After EVAR. J Endovasc Ther 2005; 12:512-5. [PMID: 16048385 DOI: 10.1583/05-1554.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To report an unusual late complication of endovascular aneurysm repair: an arteriovenous fistula between the aneurysm sac and a retro-aortic left renal vein following sac expansion due to a type III endoleak. CASE REPORT A 79-year-old man developed an arteriovenous fistula between the aneurysm sac and a retro-aortic left renal vein 67 months after endovascular aneurysm exclusion (EVAR). Aneurysm rupture was due to disconnection between the right iliac limb and an extender cuff. The problem was repaired percutaneously with another endograft bridging the two prostheses. At 16 months, the aneurysm sac diameter was decreased; there was no evidence of the AV fistula, and the patient was free from any complication related to the EVAR. CONCLUSIONS This case emphasizes the need of close surveillance even in the late postoperative course of these patients. Moreover, this rare event confirmed that endovascular techniques can play an important role in treating emergent complications.
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Affiliation(s)
- Mauro Ferrari
- Unit of Vascular Surgery, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
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37
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Waldrop JL, Dart BW, Barker DE. Endovascular Stent Graft Treatment of a Traumatic Aortocaval Fistula. Ann Vasc Surg 2005; 19:562-5. [PMID: 15981116 DOI: 10.1007/s10016-005-5025-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Aortocaval fistula (ACF) is an infrequently reported sequela of trauma. Most ACF have been repaired via an open approach. During the past 10 years, there has been one reported case of spontaneous ACF and two cases of traumatic ACF repaired using an endovascular technique. We present a third case of traumatic ACF repaired with an endovascular stent graft. A 40-year-old male sustained two gunshot wounds to the right chest and one to the right upper abdomen. He was taken from the emergency department directly to the operating room, where an exploratory laparotomy was performed. Through-and-through injuries to the stomach and transverse colon were repaired primarily. Subsequently, the patient developed abdominal compartment syndrome. An urgent exploratory laparotomy was performed, revealing a nonbleeding hematoma on the posterior lateral surface of the right lobe of the liver, which was left undisturbed. Open abdominal management was instituted with vacuum pack closure. On the nineteenth hospital day, the patient again had a significant decrease in hematocrit. An aortogram was performed in order to evaluate the patient for intrahepatic arterial bleeding amenable to transcatheter embolization. There was no evidence of hepatic arterial bleeding. However, a supraceliac ACF was identified. The patient was taken to the operating room, and an AneuRx aortic extension cuff was advanced under fluoroscopy and deployed to cover the fistula. Completion angiography revealed total obliteration of the ACF and appropriate placement of the stent graft. Postoperatively, the patient was returned to the intensive care unit, where his hospital course was complicated by ventilator-associated pneumonia and sepsis. Repeat computed tomographic scanning 6 months and 1 year following this repair demonstrated patency of the graft without evidence of graft migration or aortocaval communication. Further research and experience are necessary with this technique regarding long-term outcome and technical aspects. In particular, the sizing problems associated with repair of acute traumatic ACF in emergency situations should be addressed. The endovascular approach provides an attractive and exciting alternative to traditional methods for repair of ACF.
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Affiliation(s)
- Jimmy L Waldrop
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga Unit, Chattanooga, Tennessee 37403, USA
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38
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Burke C, Mauro MA. SIR 2003 film panel case 8: aortocaval fistula supplied by a type II endoleak. J Vasc Interv Radiol 2003; 14:813-7. [PMID: 12817053 DOI: 10.1097/01.rvi.0000079996.80153.79] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
MESH Headings
- Aged
- Aorta, Abdominal/abnormalities
- Aorta, Abdominal/diagnostic imaging
- Aorta, Abdominal/surgery
- Aortic Aneurysm, Abdominal/complications
- Aortic Aneurysm, Abdominal/diagnosis
- Aortic Aneurysm, Abdominal/surgery
- Arteriovenous Fistula/diagnosis
- Arteriovenous Fistula/etiology
- Arteriovenous Fistula/surgery
- Blood Vessel Prosthesis Implantation
- Humans
- Male
- Mesenteric Artery, Inferior/diagnostic imaging
- Mesenteric Artery, Inferior/pathology
- Mesenteric Artery, Inferior/physiopathology
- Stents
- Tomography, X-Ray Computed
- Vascular Patency/physiology
- Vena Cava, Inferior/abnormalities
- Vena Cava, Inferior/diagnostic imaging
- Vena Cava, Inferior/surgery
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Affiliation(s)
- Charles Burke
- Department of Radiology, University of North Carolina, School of Medicine, Chapel Hill, NC 27599, USA
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39
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Hinchliffe RJ, Braithwaite BD, Hopkinson BR. The endovascular management of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2003; 25:191-201. [PMID: 12623329 DOI: 10.1053/ejvs.2002.1846] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Endovascular aneurysm repair (EVAR) is a controversial technique, which remains the subject of a number of prospective randomised trials. Although questions remain regarding its long-term durability objective evidence exists which demonstrates its reduced physiological impact compared with conventional open repair. If this technique could be used in patients with ruptured abdominal aortic aneurysm (AAA) it may reduce the high peri-operative mortality. A review of the literature identified a limited experience with EVAR of ruptured AAA. Only a small number of case series with selected patients exist. The majority of patients were haemodynamically stable. However, the selective use of aortic occlusion balloons allowed successful endovascular management in a small number of unstable cases. All investigators had access to an "off the shelf" endovascular stent-graft (EVG). Per-operative mortality ranged from 9 to 45% and may reflect increasing experience and patient selection. A number of patients who underwent successful EVAR were turned down for open repair. A number of important lessons have been learned from these studies but questions remain regarding patient suitability and staffing issues. If these difficulties can be surmounted then the technique may offer an alternative to open repair.
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Papadoulas S, Konstantinou D, Kourea HP, Kritikos N, Haftouras N, Tsolakis JA. Vascular injury complicating lumbar disc surgery. A systematic review. Eur J Vasc Endovasc Surg 2002; 24:189-95. [PMID: 12217278 DOI: 10.1053/ejvs.2002.1682] [Citation(s) in RCA: 204] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to review the literature concerning the early and late vascular complications of lumbar disc surgery. METHODS using the MEDLINE database, we reviewed all reports of vascular complications associated with surgical excision of a prolapsed disc via a posterior approach reported in the English literature since 1965. RESULTS we identified 98 cases of vascular complications for an incidence of 1-5 in 10000 disc operations. Early presentation is shock due to rupture of a large retroperitoneal vessel. Late complications include development of pseudoaneurysms and arteriovenous fistulas. Treatment of a vascular tear consisted mainly of primary suturing of the injured vessel. The preferred method for arteriovenous fistula and pseudoaneurysm repair was suturing from within the arterial lumen along with interposition grafting. Recently, endovascular techniques have been recommended, lowering the high morbidity and mortality related to conventional repair. CONCLUSION iatrogenic vascular injury during lumbar disc surgery, although rare, should be suspected if signs of circulatory instability are noted or if lumbar pain, leg oedema or high output cardiac failure develop months to years following such surgical procedures. However, these symptoms may arise during or immediately after surgery, requiring immediate intervention.
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Affiliation(s)
- S Papadoulas
- Department of Surgery, Vascular Surgery Unit, University Hospital of Patras, Patras, Greece
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Duxbury MS, Wells IP, Roobottom C, Marshall A, Lambert AW. Endovascular repair of spontaneous non-aneurysmal aortocaval fistula. Eur J Vasc Endovasc Surg 2002; 24:276-8. [PMID: 12217293 DOI: 10.1053/ejvs.2002.1708] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M S Duxbury
- Vascular Surgical Unit, Derriford Hospital, Plymouth, Devon, PL6 8DH, UK
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Gandini R, Ippoliti A, Pampana E, Ascoli Marchetti A, Pistolese GR, Simonetti G. Emergency Endograft Placement for Recurrent Aortocaval Fistula After Conventional AAA Repair. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0208:eepfra>2.0.co;2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gandini R, Ippoliti A, Pampana E, Ascoli Marchetti A, Raimondo Pistolese G, Simonetti G. Emergency endograft placement for recurrent aortocaval fistula after conventional AAA repair. J Endovasc Ther 2002; 9:208-11. [PMID: 12010102 DOI: 10.1177/152660280200900212] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report a novel case in which a stent-graft was used to emergently treat an aortocaval fistula that recurred after conventional abdominal aortic aneurysm (AAA) repair. CASE REPORT A 67-year-old man was treated urgently for ruptured AAA with surgical placement of a 16-mm Dacron interposition graft. During the procedure, an aortocaval fistula was repaired primarily. The patient was discharged in satisfactory condition but returned 20 days later with dyspnea, bilateral perimalleolar edema, and a bruit in the mesogastric region. The high flow fistula was again present just above the aortic bifurcation at the distal anastomosis of the existing graft. The patient's condition deteriorated rapidly, so a bifurcated Vanguard stent-graft was deployed in an emergency procedure. Subsequent imaging confirmed satisfactory closure of the fistula. The patient was discharged 8 days after endograft placement, and he continues to be without signs of fistula recurrence at 2 years. CONCLUSIONS Endograft treatment of vascular lesions in the acute setting is becoming more common as our experience with the devices grows. Endovascular repair of primary aortocaval fistulas appears to be an efficacious and minimally invasive means of dealing with these lesions in AAA patients.
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Affiliation(s)
- Roberto Gandini
- Department of Radiology, Tor Vergata University, Rome, Italy.
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