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Online ISSN 1827-1847
Bracale U. M., Del Guercio L., Porcellini M., Bracale G.
Department of Vascular and Endovascular Surgery, Federico II University, Naples, Italy
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