Purpose: To present a patient with ruptured abdominal aortic aneurysm (AAA) and aortocaval fistula who was successfully treated with endovascular aneurysm repair in spite of developing a massive endoleak. Case Report: A 70-year-old man with ruptured AAA and aortocaval fistula was treated with endovascular aneurysm repair (EVAR). During 8 years of follow-up, he had massive perfusion of the aneurysm sac by retrograde flow from the inferior mesenteric artery into the caval vein through the aortocaval fistula. The aneurysm diameter decreased continuously in spite of the type II endoleak. This observation illustrates the mechanisms of sac expansion and may have therapeutic implications for complicated type II endoleaks and prevention of spinal cord ischemia in thoracic stent-grafting. Conclusion: EVAR can be applied in this rare setting because the ensuing high-flow endoleak is associated with sac shrinkage owing to depressurization by the caval shunt.
IMPROVE Trial Investigators. The effect of aortic morphology on peri-operative mortality of ruptured abdominal aortic aneurysm. Eur Heart J. 2015;36:1328–1334.
4.
van de LuijtgaardenKMBastos GoncalvesFRouwetEVConservative management of persistent aortocaval fistula after endovascular aortic repair. J Vasc Surg. 2013;58:1080–1083.
5.
MelasNSaratzisASaratzisNInferior vena cava stent-graft placement to treat endoleak associated with an aortocaval fistula. J Endovasc Ther. 2011;18:250–254.
6.
BobadillaJLWynnMTeferaGLow incidence of paraplegia after thoracic endovascular aneurysm repair with proactive spinal cord protective protocols. J Vasc Surg. 2013;57:1537–1542.
7.
NozdrzykowskiMEtzCDLuehrMOptimal treatment for patients with chronic Stanford type B aortic dissection: endovascularly, surgically or both?Eur J Cardiothorac Surg. 2013;44:e165–e174.
8.
ReillyLMChuterTA. Reversal of fortune: induced endoleak to resolve neurological deficit after endovascular repair of thoracoabdominal aortic aneurysm. J Endovasc Ther. 2010;17:21-29.
9.
HarrisonSCAguOHarrisPLElective sac perfusion to reduce the risk of neurologic events following endovascular repair of thoracoabdominal aneurysms. J Vasc Surg. 2012;55:1202–1205.
10.
CabrolCPavieAMesnildreyPLong-term results with total replacement of the ascending aorta and reimplantation of the coronary arteries. J Thorac Cardiovasc Surg. 1986;91:17–25.
11.
VogtPRAkinturkHBettexDAModification of surgical aortoatrial shunts for inaccessible bleeding in aortic surgery—modification of the Cabrol-shunt technique. Thorac Cardiovasc Surg. 2001;49:240-242.
