Emergency Endovascular Repair of Aortocaval Fistula-A Single Center Experience

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.

Keywords

aortocaval fistula abdominal aortic aneurysm emergency endovascular repair

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References

Schmidt R. , Bruns C. , Walter M. , Erasmi H. Aorto-caval fistula- an uncommon complication of infrarenal aortic aneurysms . Thorac Cardiovasc Surg. 1994;42(4):208-211.

Waldrop JL Jr , Dart BW 4th , Barker DE Endovascular stent graft treatment of a traumatic aortocaval fistula. Ann Vasc Surg. 2005; 19(4):562-565.

Syme J. Case of spontaneous varicose aneurysm. Edinb Med Surg J. 1831;36:1045.

Guzzardi G. , Fossaceca R. , Divenuto I. , Musiani A. , Brustia P. , Carriero A. Endovascular treatment of ruptured abdominal aortic aneurysm with aortocaval fistula. Cardiovasc Intervent Radiol. 2010; 33(4):853-856.

Lau LL , O’Reilly MJ , Johnston LC , Lee B. Endovascular stent-graft repair of primary aortocaval fistula with an abdominal aortoiliac aneurysm. J Vasc Surg. 2001;33(2):425-428.

Maeda H. , Umezawa H. , Goshima M. , et al. Surgery for ruptured abdominal aortic aneurysm with an aortocaval and iliac vein fistula. Surg Today. 2007;37(6):445-448.

Kopp R. , Weidenhagen R. , Hoffmann R. , et al. Immediate endovascular treatment of an aortoiliac aneurysm ruptured into the inferior vena cava. Ann Vasc Surg. 2006;20(4):525-528.

Clevert DA , Stickel M. , Flach P. , et al. Contrast-enhanced ultrasound in detection and follow-up of an infrarenal abdominal aortic aneurysm with aorto-caval fistula and endovascular treatment. Cardiovasc Intervent Radiol. 2007 ;30(3):480-484.

Leon LR, Jr , Arslan B. , Ley E. , Labropoulos N. Endovascular therapy of spontaneous aortocaval fistulae associated with abdominal aortic aneurysms. Vascular . 2007;15(1):35-40.

10.

Beveridge CJ , Pleass HC , Chamberlain J. , Wyatt MG , Rose JD Aortoiliac aneurysm with arteriocaval fistula treated by a bifurcated endovascular stent-graft. Cardiovasc Intervent Radiol. 1998;21(3):244-246.

11.

Juszkat R. , Pukacki F. , Zarzecka A. , Kulesza J. , Majewski W. Endovascular treatment of ruptured abdominal aneurysm into the inferior vena cava in patient after stent graft placement. Cardiovasc Intervent Radiol. 2009;32(4):776-780.

12.

Fujisawa Y. , Kurimoto Y. , Morishita K. , et al. Aortocaval fistula after endovascular stent-grafting of abdominal aortic aneurysm. J Cardiovasc Surg (Torino). 2009;50(3):387-389.

13.

Hetzel G. , Gabriel P. , Rompel O. , Ritter W. , Raithel D. Aortocaval fistula after stent-graft repair. J Endovasc Ther. 2006;13(1):117-120.

14.

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(2):208-211.

15.

Umscheid T. , Stelter WJ Endovascular treatment of an aortic aneurysm ruptured into the inferior vena cava. J Endovasc Ther. 2000;7(1):31-35.

16.

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(6):640-643.