Total amount: € 0,00
Frequency: 3 issues
Online ISSN 1827-1766
Spialtini C. 1, Freni L. 2, Santuari D. 2, Rigamonti P. 3, Cariati M. 3, Dallatana R. 2
1 Vascular Surgery Medical School, University of Milan, Milan, Italy;
2 Vascular Surgery Unit, San Carlo Borromeo Hospital, Milan, Italy;
3 Interventional Radiology Unit, Department of Radiology, San Carlo Borromeo Hospital, Milan, Italy
We report the case of a patient who developed an iliac-caval fistula after surgery for ruptured abdominal aortic aneurysm repair in 2008. The arteriovenous fistula was detected with color flow Doppler ultrasonography. A contrast-enhanced computed tomography confirmed this diagnosis and allowed to plan an endovascular treatment. The patient, an 84-year-old man, complained for recent onset of mild dyspnea. Physical examination did not reveal signs related to this condition. Blood tests were normal. Transthoracic echocardiography showed normal left ventricular volume and wall thickness with conserved systolic function and mild depressed diastolic function (grade I). Inferior vena cava showed normal inspiratory collapse. Ejection fraction was estimated at 70%.
The patient successfully underwent endovascular treatment. The procedure was entirely performed percutaneously. A GORE® VIABAHN® endoprothesis was implanted into the right prosthetic branch overlaying the anastomotic rim. The patient was discharged 4 days later. Major abdominal arteriovenous fistulae presenting after open abdominal aneurysm repair are extremely rare. They can lead to potentially life-threatening conditions as high-output heart failure, pulmonary edema, renal insufficiency, shock and finally death. Major abdominal arteriovenous fistulae can be treated either with open or endovascular techniques. Open surgical repair is associated to high morbidity and mortality, especially in emergency cases, whereas endovascular treatment seems to have better patient outcomes.