An unusual complication after endovascular aneurysm repair for giant abdominal aortic aneurysm with aortocaval fistula: High bilirubin levels

Abstract

Abdominal aortic aneurysm has among its rare complications the aortocaval fistula. It is observed in less than 1% of all abdominal aortic aneurysms and represents 3%–7% of clinical presentation in case of rupture. A male patient was presented to the emergency department with pulsating mass with continuous vascular systo-diastolic bruit, located in the lower part of abdomen with the back pain radiating anteriorly in lower abdomen. After diagnosis of abdominal aortic aneurysm with aortocaval fistula, a trimodular Endurant endograft was placed. Migration of the endoprosthesis was treated with Endoanchor and endovascular aneurysm sealing device. In the postoperative course, the patient had jaundice due to high bilirubin levels, cholestasis and increased hepatocyte cytolysis: aspartate aminotransferase and alanine aminotransferase. The treatment with appropriate continuous filtration rapidly reduced bilirubin values and the patient gradually improved.

Endovascular Occlusion of Iliocaval Confluence During Surgical Repair of Iliocaval Fistula due to Ruptured Abdominal Aortoiliac Aneurysm

“…Aortocaval and iliocaval fistulas are a rare complication of AIAA. They occur in 3–7% of ruptures 1,3,5,6,11,12 and iliocaval fistulas account for approximately 20% of cases. 13 Perioperative mortality is very high, with rates varying from 20–55% 8 to 67% depending on the series.…”

“…Open surgery is associated with high mortality rates (30–50%) due to massive bleeding. 13 Other options include total endovascular repair can be a good option, especially (particularly in patients with a high surgical risk) 5 and hybrid techniques with caval stent graft placement. 9,14 Occlusion of the IV or ICV with a balloon catheter inserted through the femoral vein has been used to prevent massive bleeding.…”

“…1-4 They are rare, life-threatening complications that occur in <1% of abdominal aortoiliac artery aneurysms (AIAAs) and in 3–7% of cases of AIAA rupture. 1,5,6…”

“…Because the symptoms of aortocaval and iliocaval fistulas are non-specific, preoperative diagnosis rates are low (0–50% according to some series). 5,6,8 A presumptive diagnosis must be confirmed by computed tomography angiography (CTA) to ensure early surgical repair. 6…”

“…[1][2][3][4] They are rare, lifethreatening complications that occur in <1% of abdominal aortoiliac artery aneurysms (AIAAs) and in 3-7% of cases of AIAA rupture. 1,5,6 Classic symptoms such as abdominal and/or back pain, a pulsatile mass and an abdominal machinery bruit, present in only 40% of cases. 6 Other relatively common clinical presentations include shock, lower limb edema, congestive heart failure, scrotal edema or hematoma, hematuria, oliguriaanuria, and renal insufficiency.…”