Endovascular treatment of an aortocaval fistula caused by a late type II endoleak
An aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysms (AAAs) and constitute <1% of all AAAs, which increases from 2% to 6.7% in ruptured AAAs. Unlike other aortic ruptures, most ACFs are not associated with significant blood loss on admission. The traditional treatment...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | Journal of Vascular Surgery Cases and Innovative Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468428724000200 |
| _version_ | 1827311148389629952 |
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| author | Giulio Accarino, MD Alessandra Benenati, MD Giancarlo Accarino, MD Francesco De Vuono, MD Giovanni Fornino, MD Gennaro Galasso, MD, PhD Umberto Marcello Bracale, MD, PhD |
| author_facet | Giulio Accarino, MD Alessandra Benenati, MD Giancarlo Accarino, MD Francesco De Vuono, MD Giovanni Fornino, MD Gennaro Galasso, MD, PhD Umberto Marcello Bracale, MD, PhD |
| author_sort | Giulio Accarino, MD |
| collection | DOAJ |
| description | An aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysms (AAAs) and constitute <1% of all AAAs, which increases from 2% to 6.7% in ruptured AAAs. Unlike other aortic ruptures, most ACFs are not associated with significant blood loss on admission. The traditional treatment strategy has been open surgery, which is associated with a high mortality rate. Endovascular repair has been performed; however, the results are difficult to interpret due to the low incidence of ACFs and the absence of cases reported with a long follow-up duration. We report the case of a 78-year-old man with previous endovascular aneurysm repair performed in 2015, who presented to our emergency department 6 years later with abdominal pain. A computed tomography angiography scan showed type Ia, Ib, and II endoleaks and an ACF. The endoleaks were selectively treated, and the ACF was covered with a polytetrafluoroethylene endograft inserted in the inferior vena cava. In our single-case experience with a medium-term follow-up of 24 months, our treatment was safe and effective for ACF closure, with no further signs of endoleak or graft thrombosis. We conducted a literature review of reported cases in which a covered stent graft was used for ACF treatment. Although no guidelines are currently available regarding this rare late complication after endovascular aneurysm repair, using a covered stent placed in the inferior vena cava to treat an ACF could be a viable option in selected cases. |
| first_indexed | 2024-03-07T20:04:22Z |
| format | Article |
| id | doaj.art-acced1ff7386436ca84080aff8c7365c |
| institution | Directory Open Access Journal |
| issn | 2468-4287 |
| language | English |
| last_indexed | 2024-04-24T20:12:19Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Vascular Surgery Cases and Innovative Techniques |
| spelling | doaj.art-acced1ff7386436ca84080aff8c7365c2024-03-23T06:25:38ZengElsevierJournal of Vascular Surgery Cases and Innovative Techniques2468-42872024-04-01102101436Endovascular treatment of an aortocaval fistula caused by a late type II endoleakGiulio Accarino, MD0Alessandra Benenati, MD1Giancarlo Accarino, MD2Francesco De Vuono, MD3Giovanni Fornino, MD4Gennaro Galasso, MD, PhD5Umberto Marcello Bracale, MD, PhD6Vascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy; Vascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy; Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy; Correspondence: Giulio Accarino, MD, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi 84100, ItalyVascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, ItalyDepartment of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, ItalyVascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, ItalyVascular and Endovascular Surgery Unit, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, ItalyDepartment of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, ItalyVascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, ItalyAn aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysms (AAAs) and constitute <1% of all AAAs, which increases from 2% to 6.7% in ruptured AAAs. Unlike other aortic ruptures, most ACFs are not associated with significant blood loss on admission. The traditional treatment strategy has been open surgery, which is associated with a high mortality rate. Endovascular repair has been performed; however, the results are difficult to interpret due to the low incidence of ACFs and the absence of cases reported with a long follow-up duration. We report the case of a 78-year-old man with previous endovascular aneurysm repair performed in 2015, who presented to our emergency department 6 years later with abdominal pain. A computed tomography angiography scan showed type Ia, Ib, and II endoleaks and an ACF. The endoleaks were selectively treated, and the ACF was covered with a polytetrafluoroethylene endograft inserted in the inferior vena cava. In our single-case experience with a medium-term follow-up of 24 months, our treatment was safe and effective for ACF closure, with no further signs of endoleak or graft thrombosis. We conducted a literature review of reported cases in which a covered stent graft was used for ACF treatment. Although no guidelines are currently available regarding this rare late complication after endovascular aneurysm repair, using a covered stent placed in the inferior vena cava to treat an ACF could be a viable option in selected cases.http://www.sciencedirect.com/science/article/pii/S2468428724000200Aortocaval fistulaEndoleakEVAR |
| spellingShingle | Giulio Accarino, MD Alessandra Benenati, MD Giancarlo Accarino, MD Francesco De Vuono, MD Giovanni Fornino, MD Gennaro Galasso, MD, PhD Umberto Marcello Bracale, MD, PhD Endovascular treatment of an aortocaval fistula caused by a late type II endoleak Journal of Vascular Surgery Cases and Innovative Techniques Aortocaval fistula Endoleak EVAR |
| title | Endovascular treatment of an aortocaval fistula caused by a late type II endoleak |
| title_full | Endovascular treatment of an aortocaval fistula caused by a late type II endoleak |
| title_fullStr | Endovascular treatment of an aortocaval fistula caused by a late type II endoleak |
| title_full_unstemmed | Endovascular treatment of an aortocaval fistula caused by a late type II endoleak |
| title_short | Endovascular treatment of an aortocaval fistula caused by a late type II endoleak |
| title_sort | endovascular treatment of an aortocaval fistula caused by a late type ii endoleak |
| topic | Aortocaval fistula Endoleak EVAR |
| url | http://www.sciencedirect.com/science/article/pii/S2468428724000200 |
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