A 72-year-old man with sudden abdominal pain and congestive cardiac failure presented a high-flow aortocaval fistula with a large abdominal aortic aneurysm as detected by Duplex ultrasonography and computed tomography angiography. As the patient’s multiple comorbidities precluded open repair, an emergency left aortouniiliac stent-graft deployment and femoro-femoral crossover bypass grafting were performed. Notwithstanding, incomplete exclusion of the fistula due to a small inflow from the contralateral iliac axis, the patient’s cardiac overload decreased with a rapid resolution of cardiac failure, allowing for a staged ligation of the right iliac artery with a complete occlusion of the aortocaval fistula. At present there have been only 12 known cases, including our own, of patients treated with aortic stent-grafts; however, in consideration of the high mortality rate of open repair, endovascular repair is increasingly being recognized as a valuable treatment option.

Emergency endovascular repair of an acute aortocaval fistula with AAA: case report and review of the literature

BRACALE, UMBERTO MARCELLO;DEL GUERCIO, LUCA;PORCELLINI, MASSIMO;BRACALE, GIANCARLO
2009

Abstract

A 72-year-old man with sudden abdominal pain and congestive cardiac failure presented a high-flow aortocaval fistula with a large abdominal aortic aneurysm as detected by Duplex ultrasonography and computed tomography angiography. As the patient’s multiple comorbidities precluded open repair, an emergency left aortouniiliac stent-graft deployment and femoro-femoral crossover bypass grafting were performed. Notwithstanding, incomplete exclusion of the fistula due to a small inflow from the contralateral iliac axis, the patient’s cardiac overload decreased with a rapid resolution of cardiac failure, allowing for a staged ligation of the right iliac artery with a complete occlusion of the aortocaval fistula. At present there have been only 12 known cases, including our own, of patients treated with aortic stent-grafts; however, in consideration of the high mortality rate of open repair, endovascular repair is increasingly being recognized as a valuable treatment option.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/418424
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