Aorto-caval fistula from acute rupture of an abdominal aortic aneurysm treated with a hybrid approach

Siepe, Matthias; Koeppe, Sabrina; Euringer, Wulf; Schlensak, Christian

doi:10.1016/j.jvs.2008.12.074

Cited by 30 publications

(19 citation statements)

References 8 publications

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“…El tratamiento de la FAo-C en la urgencia generalmente es cierre término-terminal de aorta y venorrafia de la VCI 5 . El tratamiento también puede ser híbrido, con implante de endoprótesis en VCI y cierre a cielo abierto de la aorta 6 . Nosotros tratamos al paciente con una endoprótesis a nivel arterial y embolización de una rama de la arteria hipogástrica que alimentaba la fístula.…”

Section: Discussionunclassified

Tratamiento endovascular de fístula aorto-cava

Villegas¹,

Riolo²,

Miño³

et al. 2019

RACI

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RESUMENLa fístula aorto-cava es una patología muy poco frecuente, que generalmente se da como complicación del aneurisma de aorta abdominal aterosclerótico. Se presenta un paciente con antecedentes de herida de arma de fuego en abdomen, a quien se le realizó rafia en vena cava inferior. Ingreso por fiebre, evolucionó con insuficiencia cardíaca y sospecha de tromboembolismo de pulmón. Se realizó angio-TC que confirma el diagnóstico de tromboembolismo de pulmón y se observó fístula aorto-cava. Se realizó implante de endoprótesis aórtica y embolización de una rama de la arteria hipogástrica. Evolucionó sin insuficiencia cardiaca ni nuevas reintervenciones en el seguimiento a los 3 años.Palabras claves: fístula aorto-cava, herida de arma de fuego, insuficiencia cardíaca, tratamiento endovascular.ABSTRACT Aorto-caval fistula is a very rare pathology, that usually occurs as a complication of an abdominal aortic aneurysm atherosclerotic. A patient with a history of a gunshot wound in the abdomen is presented, who underwent repair of the inferior vena cava. Then admission for fever, evolved with heart failure and suspected lung thromboembolism. CT scan was performed confirming the diagnosis of lung thromboembolism, aorto-caval fistula was observed. Endovascular treatment was performed with implant of aortic endoprothesis and embolization of the hypogastric artery. Evolved without heart failure or new reinterventions at 3 years follow up.

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Section: Discussionunclassified

Tratamiento endovascular de fístula aorto-cava

Villegas¹,

Riolo²,

Miño³

et al. 2019

RACI

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“…Although the Immediate Management of the Patient with Rupture: Open versus Endovascular Repair (IMPROVE) aneurysm trial 48 reported that endovascular repair was not associated with significant reduction in 30-day mortality in patients with ruptured AAAs, many proponents feel that if patients can be treated by EVAR, survival is superior. The limiting factor in many cases of open repair for ruptured aneurysms with ACF is that the institution does not offer the appropriate endovascular graft “off the shelf.” Siepe et al 16 presented a hybrid approach in 2009. The patient presented with malperfusion and rapidly deteriorated into shock; 2 aortic stent grafts (Medtronic Inc, Fidley, MN) were placed into the IVC first then after hemodynamics stabilized, transitioned to an open repair.…”

Section: Discussionmentioning

confidence: 99%

Aortocaval Fistula: Is Endovascular Repair the Preferred Solution?

Orion

Beaulieu

Black

2016

Annals of Vascular Surgery

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Background To compare outcomes of open and endovascular repair of aortocaval fistulas (ACFs) in the setting of abdominal aortic aneurysms (AAAs). Methods A literature review was undertaken on Pubmed from 1999 to 2014 to identify reported cases of both endovascular and open repair of ACF, including the index case, presented here. Primary outcomes for endovascular repair were: complications, presence of endoleak, and death. Primary outcomes for open repair were: complications and death. Results Forty articles were reviewed with a total of 67 patients, including the index case. Endovascular approach was used in 26 patients (39%). Endoleaks were present in 50%, whereas similarly 46% of patients had a reported complication. Five deaths (19%) occurred in the endovascular group. Open repair was performed in 41 cases (61%). The rate of complication and the death in open repair were 36% and 12%, respectively (P = 0.327 and P = 0.910, respectively) compared with endovascular. Mean follow-up was 7.7 months for the endovascular group and 8.5 months in the open group. Conclusions Previous demonstrations of high morbidity and mortality with open repair of ACF in the setting of AAA have motivated endovascular approaches. However, endoleaks are a significant problem and were present in 50% of ACF cases. The continued presence of an endoleak in the setting of an ACF may result in persistence of the ACF, unlikely thrombosis of the endoleak, and continued sac enlargement. Endovascular repair presents theoretical benefit, yet is not associated with a reduced rate of complication or death versus open repair in this contemporary review.

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“…6 One case report described a patient unsuitable for endovascular aortic repair after which from inside the vein the fistula was covered with a stent graft followed by an open interposition graft of the ruptured aneurysm reducing blood loss significantly. 7 Mortality rates of 30e40% are still favorable compared with retroperitoneal or intraperitoneal ruptured abdominal aortic aneurysm repairs.…”

Section: Discussionmentioning

confidence: 99%