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Benbrahim FZ, Ankri M, Fariyou A, El Aoufir O, Laamrani FZ, Laila J. Spontaneous ilio-iliac arteriovenous fistula: A rare complication of aorto-iliac aneurysm. Radiol Case Rep 2024; 19:2996-3000. [PMID: 38737172 PMCID: PMC11087909 DOI: 10.1016/j.radcr.2024.04.007] [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: 02/12/2024] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 05/14/2024] Open
Abstract
Ilio-iliac arteriovenous fistula is an unusual complication of aorto-iliac aneurysms that can occur spontaneously, traumatically or iatrogenically. The typical clinical presentation includes the characteristic triad of high-output heart failure, a pulsatile abdominal mass with unilateral limb ischemia, or signs of venous congestion. We describe a rare case of spontaneous rupture of an aortoiliac aneurysm into the left common iliac vein of a 65-year-old man, easily diagnosed by angiography. We highlight here the angiographic findings of the ilio-iliac fistula, which was the means of diagnosis in this presentation, especially in patients with atypical clinical features at the outset, and we report the difficulties in choosing the optimal vascular approach.
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Affiliation(s)
- Fatima Zohra Benbrahim
- Department of Emergency Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Majda Ankri
- Department of Emergency Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Asmae Fariyou
- Department of Emergency Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Omar El Aoufir
- Department of Emergency Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Fatima Zahra Laamrani
- Department of Emergency Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Jroundi Laila
- Department of Emergency Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
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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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Tanaka C, Furuya H, Kamei S, Suda S, Yamaguchi M. Endovascular Repair for Abdominal Aneurysm with Concomitant Aortoiliac Vein Fistula Diagnosed by Four-Dimensional Computed Tomography. Ann Vasc Dis 2022; 15:337-340. [PMID: 36644261 PMCID: PMC9816039 DOI: 10.3400/avd.cr.22-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/27/2022] [Indexed: 12/25/2022] Open
Abstract
A 78-year-old man complaining of left leg swelling was diagnosed with an abdominal aortic aneurysm with an irregular margin. A four-dimensional computed tomography (CT) showed an aortoiliac vein fistula. An AFX stent graft was urgently implanted, and a Viabahn VBX was inserted into the left iliac vein. The aneurysmal sac was embolized. After the procedure, enhanced CT confirmed a patent stent graft without any endoleak or fistula. The patient was discharged ambulatory. An aortoiliac vein fistula is a differential diagnosis for leg edema, and a four-dimensional CT is beneficial in diagnosing the condition.
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Affiliation(s)
- Chiharu Tanaka
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan,Corresponding author: Chiharu Tanaka, MD, PhD. Department of Cardiovascular Surgery, Tokai University Hachioji Hospital, Ishikawamachi 1838, Hachioji, Tokyo 192-0032, Japan Tel: +81-42-639-1111, Fax: +81-42-639-1112, E-mail:
| | - Hidekazu Furuya
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Shunsuke Kamei
- Department of Radiology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Satoshi Suda
- Department of Radiology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Masaomi Yamaguchi
- Department of Cardiovascular Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
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Naouli H, Jiber H, Bouarhroum A. Iliac arteriovenous fistula following lumbar disc surgery. A case report. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:199-202. [PMID: 36344032 DOI: 10.1016/j.jdmv.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Iliac arteriovenous (AV) fistula after lumbar disc surgery are uncommon entities with limited reported cases. This report describes a 44-year-old man with history of L4-L5 spinal discectomy who complained of congestive heart failure symptoms four years later. Computed tomography angiography (CTA) revealed an AV fistula connecting the right common iliac artery and vein. AV closure with lateral suturing of common iliac artery and vein was performed through transperitoneal aorto-iliac approach. Postoperatively, the patient's symptoms of orthopnea resolved. Follow-up at six years was uneventful.
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Affiliation(s)
- H Naouli
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University Boite Postale 1893 - KM 2.200, route Sidi Harazem Fès, 30070 Morocco; Vascular surgery department, UHC Hassan II Fez, Morocco.
| | - H Jiber
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University Boite Postale 1893 - KM 2.200, route Sidi Harazem Fès, 30070 Morocco; Vascular surgery department, UHC Hassan II Fez, Morocco
| | - A Bouarhroum
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University Boite Postale 1893 - KM 2.200, route Sidi Harazem Fès, 30070 Morocco; Vascular surgery department, UHC Hassan II Fez, Morocco
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Sueyoshi E, Iwano Y, Oka T, Nishimura T, Honda T, Kawaguchi Y, Koike H, Nagayama H, Sakamoto I, Uetani M. The Successful Treatment of an Ilio-Iliac Fistula and Aneurysms Affecting the Abdominal Aortic and Iliac Arteries via Endovascular Stent Graft Repair. Vasc Endovascular Surg 2020; 55:91-94. [PMID: 32875955 DOI: 10.1177/1538574420953933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Spontaneous ilio-iliac arteriovenous fistula (AVF) associated with aneurysms affecting the abdominal aortic and iliac arteries is a rare condition. The classical clinical symptoms of ilio-iliac AVF include high-output heart failure, abdominal pain, abdominal bruits and thrills, a pulsatile abdominal mass, and venous congestion symptoms (leg edema and hematuria). The prompt repair of AVF is necessary to restore the patient's hemodynamics. We report a case in which a patient with aneurysms affecting the abdominal aortic and iliac arteries and an ilio-iliac AVF presented with high-output heart failure and leg ischemia and was successfully treated via endovascular stent graft repair.
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Affiliation(s)
- Eijun Sueyoshi
- Department of Radiology, 12961Nagasaki University School of Medicine, Nagasaki, Japan.,Department of Radiological Science, 200674Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yusuke Iwano
- Department of Radiology, 12961Nagasaki University School of Medicine, Nagasaki, Japan
| | - Taiga Oka
- Department of Radiology, 12961Nagasaki University School of Medicine, Nagasaki, Japan
| | - Takamasa Nishimura
- Department of Radiology, 12961Nagasaki University School of Medicine, Nagasaki, Japan
| | - Takahide Honda
- Department of Radiology, 12961Nagasaki University School of Medicine, Nagasaki, Japan
| | - Yutaro Kawaguchi
- Department of Cardiovascular Surgery, 12961Nagasaki University School of Medicine, Nagasaki, Japan
| | - Hirofumi Koike
- Department of Radiology, 12961Nagasaki University School of Medicine, Nagasaki, Japan
| | - Hiroki Nagayama
- Department of Radiology, 12961Nagasaki University School of Medicine, Nagasaki, Japan
| | - Ichiro Sakamoto
- Department of Radiology, 12961Nagasaki University School of Medicine, Nagasaki, Japan.,Department of Radiological Science, 200674Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiology, 12961Nagasaki University School of Medicine, Nagasaki, Japan.,Department of Radiological Science, 200674Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Hanada K, Yamamoto K, Akai T, Taniguchi R, Takayama T, Hoshina K. Phlegmasia cerulea dolens as an initial manifestation of a fistula between a ruptured iliac artery aneurysm and the iliac vein. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:41-44. [PMID: 30734007 PMCID: PMC6355442 DOI: 10.1016/j.jvscit.2018.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/05/2018] [Indexed: 11/22/2022]
Abstract
Phlegmasia cerulea dolens (PCD) is caused by obstruction of limb venous return that may result in venous gangrene and limb loss. We present a case of a fistula between a ruptured right common iliac artery aneurysm and the left common iliac vein (ilioiliac arteriovenous fistula [AVF]), which initially manifested as left PCD and acute renal failure. Resection of the aneurysm and repair of the AVF immediately improved the PCD and acute renal failure. We should be aware that an iliac AVF might present as PCD and should keep this in mind.
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Affiliation(s)
| | - Kota Yamamoto
- Correspondence: Kota Yamamoto, MD, PhD, Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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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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Barat M, Ssi Yan Kai G, Maitre S, de Laveaucoupet J. An acute abdominal syndrome reveals a postoperative ilio-iliac arteriovenous fistula: about one case. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24 Suppl 4:S577-9. [PMID: 25543918 DOI: 10.1007/s00586-014-3740-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 12/19/2014] [Accepted: 12/21/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Postoperative ilio-iliac arteriovenous fistula is an unusual but known complication after lumbar surgery. CASE REPORT We report the case of a 74-year-old patient consulted at the emergency department for intense acute abdominal syndrome revealing a post-operative common ilio-iliac arteriovenous fistula 5 years after a lumbosacral arthrodesis L3-S1. The patient was treated with an endovascular arterial stent-graft with immediate vascular and clinical results. CONCLUSION Arteriovenous fistula is a possible etiology of acute abdominal syndrome in patients with lumbar or abdominopelvic surgery history.
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Affiliation(s)
- Maxime Barat
- Service de Radiologie, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140, Clamart, France,
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Bifurcated endograft repair of ilio-iliac arteriovenous fistula secondary to lumbar diskectomy. Ann Vasc Surg 2010; 24:551.e13-7. [PMID: 20144531 DOI: 10.1016/j.avsg.2009.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 08/18/2009] [Indexed: 11/23/2022]
Abstract
Ilio-iliac arteriovenous (AV) fistula is a rare complication after lumbar diskectomy. Endovascular repair of such fistulas is a growing trend in vascular surgery. This is a case report of an endovascular exclusion of an ilio-iliac AV fistula in a 51-year-old male. This man presented with high-output congestive heart failure and ascites. The AV fistula was discovered 17 years after a lumbar diskectomy. Computed topography (CT) revealed a right common iliac artery pseudoaneurysm connecting to the left common iliac vein. The fistula was repaired using a bifurcated Gore Excluder endograft. There were follow-up CT scans at 6 and 10 months confirming exclusion of the AV fistula. Endovascular AV fistula repair offers a safe, effective method for managing ilio-iliac AV fistulas.
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