Aortocaval Fistula after Stent-Graft Repair

• Published in: Journal of endovascular therapy 2006-02, Vol.13 (1), p.117-120
• Main Authors: Hetzel, Gudrun, Gabriel, Petra, Rompel, Oliver, Ritter, Wolfgang, Raithel, Dieter
• Format: Article
• Language: English
• Subjects: Aged; Angiography; Aortic Aneurysm - pathology; Aortic Aneurysm - surgery; Aortic Rupture - etiology; Aortic Rupture - surgery; Arteriovenous Fistula - etiology; Arteriovenous Fistula - surgery; Blood Vessel Prosthesis Implantation; Humans; Iliac Vein - pathology; Male; Postoperative Complications - diagnosis; Stents; Tomography, X-Ray Computed; Ultrasonography, Doppler, Duplex; Vena Cava, Inferior - pathology
• ISSN: 1526-6028; 1545-1550
• DOI: 10.1583/05-1558MR.1

Purpose: To report an aortocaval fistula after stent-graft repair and the feasibility of interventional treatment. Case Report: A 78-year-old man with a 61-mm infrarenal aortic aneurysm (AA) was treated successfully with a Zenith bifurcated stent-graft. Three years later, the patient presented with deteriorating renal function and acute bronchial obstruction. Computed tomography showed an aortic diameter increased to 90 mm, dilatation of the inferior vena cava, and a distal type I endoleak. The patient's condition quickly deteriorated, and emergent imaging found a fistula with brisk flow between the aneurysm sac and the left iliac vein within a distal type I endoleak. During emergency endovascular repair, iliac extensions were implanted in the right common iliac artery and left external iliac artery. The left hypogastric artery was coil embolized to exclude flow into the aneurysm sac. After positioning the extensions, cardiac function improved, and the fistula was no longer palpable. The cardiac indices and renal function normalized, and he was discharged 20 days after admission. Conclusion: Aortocaval fistulas are a rare complication of AA stent-graft repair and may be successfully treated by interventional means.