Endovascular treatment of ruptured abdominal aortic aneurysm with aortocaval fistula based on aortic and inferior vena cava stent-graft placement

Ann Vasc Surg. 2014 Nov;28(8):1933.e1-5. doi: 10.1016/j.avsg.2014.06.073. Epub 2014 Jul 11.

Abstract

A ruptured abdominal aortic aneurysm (RAAA), complicated by an aortocaval fistula (ACF), is usually associated with high morbidity and mortality during open operative repair. We report a case of endovascular treatment of an RAAA with ACF. After accessing both common femoral arteries, a bifurcated aortic stent graft was placed. Subsequently, we accessed the fistula from the right femoral vein and a cava vein angiography showed a persistent massive flow from the cava to the excluded aneurysm sac. We proceeded by covering the fistula with an Excluder aortic stent-graft cuff to prevent pressurization of the aneurysm sac and secondary endoleaks. This procedure is feasible and may reduce the chances of posterior endoleaks.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aorta / physiopathology
  • Aorta / surgery*
  • Aortic Aneurysm, Abdominal / complications
  • Aortic Aneurysm, Abdominal / diagnosis
  • Aortic Aneurysm, Abdominal / physiopathology
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortic Rupture / diagnosis
  • Aortic Rupture / etiology
  • Aortic Rupture / physiopathology
  • Aortic Rupture / surgery*
  • Aortography / methods
  • Arteriovenous Fistula / diagnosis
  • Arteriovenous Fistula / etiology
  • Arteriovenous Fistula / physiopathology
  • Arteriovenous Fistula / surgery*
  • Blood Vessel Prosthesis
  • Blood Vessel Prosthesis Implantation* / instrumentation
  • Endovascular Procedures* / instrumentation
  • Hemodynamics
  • Humans
  • Male
  • Phlebography / methods
  • Stents
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Vena Cava, Inferior / diagnostic imaging
  • Vena Cava, Inferior / physiopathology
  • Vena Cava, Inferior / surgery*