Aortocaval fistula: current management strategies

Brightwell, Robert; Pegna, Victoria; Boyne, Nicholas

doi:10.1111/j.1445-2197.2012.06294.x

Cited by 50 publications

(51 citation statements)

References 26 publications

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“…The role of rapidly evolving endovascular modalities has been well documented in the treatment of AAA. The use of these newer techniques in ACF repair has gained favour in more recent years and in selected cases appears to be associated with high success rates although the rarity of the condition and reporting bias for both strategies limit any conclusions from current data regarding a survival advantage [21] . Notwithstanding the limitation of data, a recent systematic review of case reports of endovascular repair of major abdominal arteriovenous fistulas presented a 94% technical success rate and 0% and 10% intra-operative and 90-day mortality respectively [22] .…”

Section: Discussionmentioning

confidence: 93%

“…A preoperative diagnosis allows better haemostatic control and specific care to avoid paradoxical embolism due to dislodged atheromatous debris. Operative mortality is approximately 30% with open surgery due to complications such as haemorrhage, myocardial infarction, coagulopathy and thromboembolism [11,21] . The role of rapidly evolving endovascular modalities has been well documented in the treatment of AAA.…”

Section: Discussionmentioning

confidence: 99%

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Multi-organ failure secondary to an aortocaval fistula-when should it be suspected?

Medani

Walker

Leavey

2015

CRIM

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Spontaneous aortocaval fistula (ACF) is a rare, life threatening complication of abdominal aortic aneurysms (AAA) which is seldom suspected clinically. We report a case of progressive multi-organ failure secondary to an ACF wherein a delayed diagnosis was followed by a successful outcome. A 67-year-old man presented with dyspnoea on exertion, cough, and night sweats for three weeks. Initial investigations showed type 1 respiratory failure and mild renal impairment. He was treated for a suspected respiratory tract infection and fluid overload but antibiotic and diuretic therapies were ineffective. Within the following 36 hours he developed progressive azotemia and acute liver failure. He had physical signs of predominantly right-sided heart failure with preserved left ventricular systolic function on echocardiogram. Abdominal ultrasound and a non-contrast computed tomography (CT) revealed mild hepatomegaly, a 10 cm AAA with no evident leak and unremarkable kidneys. Oliguria and metabolic acidosis ensued with rapid deterioration of renal function and hypotension necessitating continuous veno-venous hemofiltration with inotropic support. Hepatic and renal function improved within a week of intensive care therapy but signs of volume overload persisted. A contrast abdominal CT demonstrated an ACF, which was successfully managed by endovascular stent-grafting. This case highlights the importance of being alert to the haemodynamic consequences of aortocaval rupture particularly in the presence of a large AAA in a patient presenting with unexplained organ failure and hyperkinetic shock. Optimisation of supportive care impacts favourably on the perioperative course and overall prognosis of this rare condition.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Multi-organ failure secondary to an aortocaval fistula-when should it be suspected?

Medani

Walker

Leavey

2015

CRIM

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“…Aorto-caval fistula resulting from ruptured abdominal aortic aneurysm was first described by Syme in 1831. present incidence ranges from 0.2% to 6% of all ruptured aortic aneurysms [1,2]. The classic triad of abdominal pain, pulsatile abdominal mass, and abdominal bruit is found in only 50% to 80% of cases [3].…”

Section: Discussionmentioning

confidence: 99%

Peritonitis as Presentation of Aorto-Caval Fistula with Salmonella choleraesuis-Associated Abdominal Aortic Aneurysm

Huang

Lin²,

Lin³

2015

Surgical Infections

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Background: The majority of aorto-caval fistulae occur spontaneously, either as a result of rupture of an existing atherosclerotic abdominal aortic aneurysm into the vena cava or secondary to iatrogenic injuries during peripheral angiography or surgery. Aorto-caval fistula from an infected aortic aneurysm is a rare scenario, but potentially lethal. Methods: Case report and review of the literature. Case Report: A 63-year-old female with diabetes mellitus and liver cirrhosis was admitted for intractable abdominal pain with rebound tenderness. A computed tomography scan demonstrated an abdominal aortic aneurysm and ill-defined peri-aortic fluid with air density and evidence of a fistula between the aorta and the inferior vena cava. Salmonella cholerasuis had been isolated from a blood culture at a previous admission. Urgent endovascular exclusion of the aorto-caval fistula was carried out, and the infra-renal abdominal aneurysm was repaired using a Cook Zenith TX2 aortic stent graft. She received parenteral ceftriaxone for four weeks. Conclusions: This case shows acceptable short-term results after endovascular repair of a Salmonella-infected aorto-caval fistula.

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“…However, reports in the literature show that this event is normally self-limiting. 18 This type of leakage appears to be subject to different dynamics, by which the low pressure of the venous system provides an exit route for retrograde flow from the aortic branches, reduces tension at the aorta wall and facilitates spontaneous resolution. 19 However, some authors suggest that, even after release of the endograft, blood flow into the aneurysm sac may be exacerbated through the fistula, which would require a second procedure to repair.…”

Section: Discussionmentioning

confidence: 99%

Tratamento endovascular de aneurisma de aorta abdominal com fístula aorto-cava utilizando oclusor vascular concomitante a endoprótese bifurcada: relato de caso

et al. 2017

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Aortocaval fistulae are rare entities with a variety of etiologies and are very often associated with significant morbidity and mortality. It is believed that increased tension in the walls of large aneurysms can cause an inflammatory reaction resulting in adhesion to the adjacent vein and culminating in erosion of the adherent layers and fistula formation. Conventional surgical treatment has high mortality rates. Paradoxical pulmonary embolism and endoleaks are the most concerning complications linked with endovascular treatment. Using a vascular occluder in combination with a bifurcated endograft is a good option for the treatment of an abdominal aortic aneurysm with aortocaval fistula.Keywords: aneurysm aortic, aortocaval fistula, endovascular procedures. ResumoAs fístulas aorto-cava são entidades raras e de etiologia variada, estando frequentemente associadas a significativa morbimortalidade. Acredita-se que o aumento da tensão da parede nos grandes aneurismas resulte em reação inflamatória e aderência à veia adjacente, culminando na erosão das camadas aderidas e na formação da fístula. O tratamento cirúrgico convencional tem altas taxas de mortalidade. Embolia pulmonar paradoxal e o vazamento são complicações temidas do tratamento endovascular. O uso de oclusor vascular associado a endoprótese bifurcada é boa opção no tratamento do aneurisma de aorta abdominal com fístula aorto-cava.Palavras-chave: aneurisma aórtico; fístula aorto-cava; procedimentos endovasculares.

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Aortocaval fistula: current management strategies

Cited by 50 publications

References 26 publications

Multi-organ failure secondary to an aortocaval fistula-when should it be suspected?

Multi-organ failure secondary to an aortocaval fistula-when should it be suspected?

Peritonitis as Presentation of Aorto-Caval Fistula with Salmonella choleraesuis-Associated Abdominal Aortic Aneurysm

Tratamento endovascular de aneurisma de aorta abdominal com fístula aorto-cava utilizando oclusor vascular concomitante a endoprótese bifurcada: relato de caso

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