CASE REPORTS   

Italian Journal of Vascular and Endovascular Surgery 2009 September;16(3):199-202

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

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