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Accarino G, Benenati A, Accarino G, De Vuono F, Fornino G, Galasso G, Bracale UM. Endovascular treatment of an aortocaval fistula caused by a late type II endoleak. J Vasc Surg Cases Innov Tech 2024; 10:101436. [PMID: 38435789 PMCID: PMC10907850 DOI: 10.1016/j.jvscit.2024.101436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/08/2024] [Indexed: 03/05/2024] Open
Abstract
An aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysms (AAAs) and constitute <1% of all AAAs, which increases from 2% to 6.7% in ruptured AAAs. Unlike other aortic ruptures, most ACFs are not associated with significant blood loss on admission. The traditional treatment strategy has been open surgery, which is associated with a high mortality rate. Endovascular repair has been performed; however, the results are difficult to interpret due to the low incidence of ACFs and the absence of cases reported with a long follow-up duration. We report the case of a 78-year-old man with previous endovascular aneurysm repair performed in 2015, who presented to our emergency department 6 years later with abdominal pain. A computed tomography angiography scan showed type Ia, Ib, and II endoleaks and an ACF. The endoleaks were selectively treated, and the ACF was covered with a polytetrafluoroethylene endograft inserted in the inferior vena cava. In our single-case experience with a medium-term follow-up of 24 months, our treatment was safe and effective for ACF closure, with no further signs of endoleak or graft thrombosis. We conducted a literature review of reported cases in which a covered stent graft was used for ACF treatment. Although no guidelines are currently available regarding this rare late complication after endovascular aneurysm repair, using a covered stent placed in the inferior vena cava to treat an ACF could be a viable option in selected cases.
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Affiliation(s)
- Giulio Accarino
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
- Vascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Alessandra Benenati
- Vascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Giancarlo Accarino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Francesco De Vuono
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Giovanni Fornino
- Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Umberto Marcello Bracale
- Vascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy
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McDonald M, Robinson E, Singh H. Staged triple endovascular approach for repair of aortocaval fistula secondary to ruptured abdominal aortic aneurysm. J Vasc Surg Cases Innov Tech 2023; 9:101335. [PMID: 38023326 PMCID: PMC10654583 DOI: 10.1016/j.jvscit.2023.101335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/12/2023] [Indexed: 12/01/2023] Open
Abstract
A primary aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysms caused by erosion of the aortic wall into the vena cava. It is more frequently observed in the setting of ruptured abdominal aortic aneurysms and presents a unique challenge for vascular surgeons. Both open and endovascular techniques exist, with the main differences being perioperative mortality and recurrence rates. We present a case of an ACF diagnosed intraoperatively, which persisted after endovascular aneurysm repair in conjunction with a type II endoleak. We applied a unique staged, triple endovascular approach to close the ACF via caval and aortic exclusion of inflow and outflow vessels.
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Affiliation(s)
- Molly McDonald
- Division of Vascular Surgery, Department of Surgery, Mount Sinai South Nassau, Mount Sinai Health System, New York, NY
| | - Eric Robinson
- Division of Vascular Surgery, Department of Surgery, Mount Sinai South Nassau, Mount Sinai Health System, New York, NY
| | - Harmandeep Singh
- Division of Vascular Surgery, Department of Surgery, Mount Sinai South Nassau, Mount Sinai Health System, New York, NY
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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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Jiao X, Zhao L, Wu Y, Chen S. Congenital aortocaval fistula combined with patent ductus arteriosus in an infant: a case report. Interact Cardiovasc Thorac Surg 2022; 35:6779987. [PMID: 36308451 PMCID: PMC9703955 DOI: 10.1093/icvts/ivac260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/05/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Congenital aortocaval fistula (ACF) is a rare cardiac malformation. While it can occur in combination with patent ductus arteriosus (PDA), this has not been reported. In this case, a 1-year-old infant had a heart murmur found in a routine physical examination, and PDA was revealed by transthoracic echocardiography and abdominal ACF was detected by three-dimensional coronary artery computed tomography. Percutaneous interventional therapy, used for ACF and PDA, was performed to occlude the malformation. The patient presented good health without any discomfort at a 1-year follow-up. The percutaneous closure of ACF and PDA with an Amplatzer vascular device can be considered an appropriate option.
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Affiliation(s)
- Xianting Jiao
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liqing Zhao
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yurong Wu
- Department of Pediatric Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sun Chen
- Corresponding author. Department of Pediatric Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, SH 200092, China. Tel:+86-25078485; e-mail: (S. Chen)
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De Boodt H, Pardon HE, Gellens P, Maleux G, Marrannes J. Balloon-assisted transcaval embolization of a type II endoleak associated with an aortocaval fistula after endovascular aortic repair. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:447-449. [PMID: 32875178 PMCID: PMC7451716 DOI: 10.1016/j.jvscit.2020.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 06/23/2020] [Indexed: 12/01/2022]
Abstract
Endovascular aortic repair is an accepted treatment option for patients with infrarenal aortic aneurysm. Type II endoleak associated with persistent aneurysmal sac growth is considered an adverse event requiring endoleak occlusion. We describe the case of a patient with type II endoleak after endovascular aortic repair for infrarenal aortic aneurysm associated with aortocaval fistula and persistent aneurysm growth. Type II endoleak embolization was successfully performed with coils and Onyx through a transcaval approach using an occlusion balloon and co-axial microcatheter.
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Affiliation(s)
- Helen De Boodt
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.,Department of Radiology, Heilig Hart Hospital, Roeselare, Belgium
| | | | - Patrick Gellens
- Department of Vascular Surgery, Heilig Hart Hospital, Roeselare, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Jesse Marrannes
- Department of Radiology, Heilig Hart Hospital, Roeselare, Belgium
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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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Shatila W, Krajcer Z. Use of an AFX aortic cuff in the endovascular treatment of aortocaval fistula secondary to abdominal aortic pseudoaneurysm. Catheter Cardiovasc Interv 2018; 92:1352-1355. [PMID: 30260090 DOI: 10.1002/ccd.27830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 05/25/2018] [Accepted: 07/23/2018] [Indexed: 11/10/2022]
Abstract
Aortocaval fistula (ACF) is rare and lethal and can be either primary (due to an enlarged abdominal aortic aneurysm) or secondary (iatrogenic or secondary to abdominal surgery) in origin. We describe a case of an ACF secondary to a ruptured abdominal aortic pseudoaneurysm that we successfully treated with a planned endovascular approach using an AFX aortic cuff on both the arterial and venous sides.
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Affiliation(s)
- Wassim Shatila
- Department of Cardiology, Texas Heart Institute, 6770 Bertner Avenue, Houston, Texas.,Department of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas.,Division of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, Texas
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, 6770 Bertner Avenue, Houston, Texas.,Department of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, Texas.,Division of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, Texas
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The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 2018; 67:2-77.e2. [DOI: 10.1016/j.jvs.2017.10.044] [Citation(s) in RCA: 1150] [Impact Index Per Article: 191.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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de Almeida BL, Rossi FH, Rodrigues TO, Ahouagi LB, Cavalcante SFA, Beteli CB, Pedra CAC, Kambara AM. Tratamento endovascular de aneurisma de aorta abdominal com fístula aorto-cava utilizando oclusor vascular concomitante a endoprótese bifurcada: relato de caso. J Vasc Bras 2017; 16:168-173. [PMID: 29930641 PMCID: PMC5915865 DOI: 10.1590/1677-5449.007916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo As fístulas aorto-cava são entidades raras e de etiologia variada, estando frequentemente associadas a significativa morbimortalidade. Acredita-se que o aumento da tensão da parede nos grandes aneurismas resulte em reação inflamatória e aderência à veia adjacente, culminando na erosão das camadas aderidas e na formação da fístula. O tratamento cirúrgico convencional tem altas taxas de mortalidade. Embolia pulmonar paradoxal e o vazamento são complicações temidas do tratamento endovascular. O uso de oclusor vascular associado a endoprótese bifurcada é boa opção no tratamento do aneurisma de aorta abdominal com fístula aorto-cava.
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Silveira PG, Cunha JRF, Barbosa Lima GB, Franklin RN, Bortoluzzi CT, Galego GDN. Endovascular Treatment of Ruptured Abdominal Aortic Aneurysm with Aortocaval Fistula Based on Aortic and Inferior Vena Cava Stent-Graft Placement. Ann Vasc Surg 2014; 28:1933.e1-5. [DOI: 10.1016/j.avsg.2014.06.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 06/05/2014] [Accepted: 06/19/2014] [Indexed: 11/16/2022]
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