Bifurcated Endograft Repair of Ilio-iliac Arteriovenous Fistula Secondary to Lumbar Diskectomy

Sarmiento, Jose M.; Wisniewski, Paul; Natalie, T.; Vo, Trung D.; Aka, Paul K.; Tayyarah, Majid; Hsu, Jeffrey H.

doi:10.1016/j.avsg.2009.08.019

Cited by 17 publications

(6 citation statements)

References 18 publications

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“…The alternative solution to this is by graft stenting in the vein, but this can only be considered in traumatic or iatrogenic injury-related cases. [13][14][15] In aneurysm-associated IIAVF cases, backflow occurs from the vein of the IIAVF into the aneurysm sac even after blocking the blood flow with a stent-graft, which may cause sac enlargement or delayed rupture. Thus, theoretically, a type II endoleak occurs and stent-grafts must be placed on both sides around the iliac artery and vein defects.…”

Section: Discussionmentioning

confidence: 99%

Endovascular repair of an ilio-iliac arteriovenous fistula following rupture of common iliac artery aneurysm with an aortic extension cuff in common iliac vein

Yoo¹

2022

Medicine

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Rationale: Common iliac artery aneurysm (CIAA) is complicated by ilio-iliac arteriovenous fistulas (IIAVF), which is rare but fatal and require prompt diagnosis and appropriate treatment. As open repair is associated with high morbidity and mortality, endovascular therapy is considered appropriate for treating an IIAVF. Patient concerns: A 76-year-old male patient who developed an IIAVF as a complication of ruptured CIAA, requiring immediate surgical repair presented to the hospital with hemodynamic instability. Diagnosis: Computed tomography angiography and conventional angiography revealed an IIAVF. Intervention: Endovascular therapy was selected to reduce the risk of morbidity and mortality. As the angiogram after the first endovascular aneurysm repair with stent-grafting showed contrast medium filling in the aneurysm sac, right common iliac vein, and the inferior vena cava, an aortic extension cuff was inserted into the right common iliac vein to close the orifice on the venous side. Outcomes: The right lower leg edema and discomfort were resolved immediately after the procedure, with the vital signs remaining stable. Computed tomography performed 6 months postoperatively showed patent stent-grafts of the artery and vein, with no evidence of IIAVF and endoleak. Lessons: IIAVF following CIAA rupture can be repaired successfully by stenting of the common iliac vein with an aortic extension cuff. For successful endovascular repair, the vein side of the fistula tract should be excluded with a stent-graft to block the backflow into the aneurysm sac.

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Section: Discussionmentioning

confidence: 99%

Endovascular repair of an ilio-iliac arteriovenous fistula following rupture of common iliac artery aneurysm with an aortic extension cuff in common iliac vein

Yoo¹

2022

Medicine

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“…Endovascular repair of such fistulas is a growing trend in vascular surgery (4). This is a case of a percutaneous endovascular exclusion of an ilio-iliac AV fistula in a 35-year-old female presenting with ascites and swelling in the legs.…”

Section: Introductionmentioning

confidence: 99%

Iliac arteriovenous fistula presenting with ascites

Yılmaz

Celıkbılek²,

Sarıkaya³

et al. 2015

Turk J Gastroenterol

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Arteriovenous fistula presents rarely with ascites. Diagnosis, with an elusive clinical presentation, is often incidental or delayed. A 35-year-old woman presented with ascites and cardiac decompensation. Contrast enhanced computed tomography revealed arteriovenous fistula between the left common iliac artery aneurysm and the left common iliac vein. The patient underwent endovascular treatment with arterial access was performed, with implantation of a stent graft in the iliac artery to cover the fistulous communication. At follow-up 1 month later, she was asymptomatic without ascites. Arteriovenous fistula should be considered in the differential diagnosis of patients with ascites and cardiac decompensation. The endovascular treatment of the arteriovenous fistula should be considered as a first line option. Keywords: Arteriovenous fistula, ascites, heart failure, endovascular procedures INTRODUCTIONAbdominal arteriovenous (AV) fistulas are rare clinical abnormalities with a rupture of an aortic or iliac aneurysm into the inferior vena cava, the iliac or renal veins (1). Clinical presentation can vary greatly but commonly includes back pain, high-output congestive cardiac failure and the presence of an abdominal bruit. Diagnosis, with an elusive clinical presentation, is often incidental or delayed (1). Clinical presentation with ascites is rare in iliac AV fistulas (2).Surgery is the traditional treatment for this condition, consisting of fistula closure and aneurysm repair, usually with an aortic or aortoiliac graft (3). Endovascular repair of such fistulas is a growing trend in vascular surgery (4). This is a case of a percutaneous endovascular exclusion of an ilio-iliac AV fistula in a 35-year-old female presenting with ascites and swelling in the legs. CASE PRESENTATIONA 35-year-old woman was referred to our out-patients clinic with ascites. She has a five months history of increased abdominal girth and breath shortness. Her complaints started and increased gradually after lumbar discectomy five month prior to admission. Physical examination revealed a blood pressure, 100/70 mm Hg; heart rate, 86 beats/min; respiratory rate, 24 breaths/min; and temperature, 36°C. Skin and sclerae were anicteric. The lungs had bilateral basal crepitations without evidence of pleural effusion. Grade 3/6 holosystolic murmur was best heard at the left midsternal border. The abdomen was massive distended with a fluid wave and shifting dullness consistent with ascites. Examination over the left lower quadrant in the abdomen revealed a thrill and bruit. Bilateral asymmetrical lower extremity edema to the ankle was noted. 2014; 25 (Suppl.- Turk J Gastroenterol 211Initial laboratory examination showed moderate bilirubin elevation with total bilirubin 1.9 mg/dL and conjugated bilirubin 0.4 mg/dL. Electrocardiogram showed normal sinus rhythm. Chest radiograph showed cardiomegaly. Abdominal ultrasonography showed advanced ascites. By color doppler ultrasonography, portal vein diameter was measured 10 mm at its midpoint. Portal ...

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“…Spontaneous iliac arteriovenous fistulae (AVF) are a rare clinical entity. Such localized fistulation is usually a result of penetrating traumatic or iatrogenic injury [ 1 ]. Clinical presentation can vary greatly but commonly includes back pain, high-output congestive cardiac failure (CCF) and the presence of an abdominal bruit.…”

Section: Introductionmentioning

confidence: 99%

“…This required sealing a proximal stent in his aorta. Bifurcated endografts have been used to seal ilio-iliac fistulae previously [ 1 ]. The aortic bifurcation diameter was 19 mm in this case and although some devices have reported success negotiating smaller aortic bifurcations [ 2 ], we felt an aorto-bi-iliac graft would be in danger of being compressed at the bifurcation with a high risk of occlusion.…”

Section: Introductionmentioning

confidence: 99%

Hybrid management of a spontaneous ilio-iliac arteriovenous fistula: a case report

et al. 2011

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IntroductionSpontaneous iliac arteriovenous fistulae are a rare clinical entity. Such localized fistulation is usually a result of penetrating traumatic or iatrogenic injury. Clinical presentation can vary greatly but commonly includes back pain, high-output congestive cardiac failure and the presence of an abdominal bruit. Diagnosis, therefore, is often incidental or delayed.Case presentationWe report a case of a spontaneous ilio-iliac arteriovenous fistula in a 68-year-old Caucasian man detected following presentation with unilateral claudication and congestive cardiac failure. Following computed tomography evaluation, the fistula was successfully treated with a combined endovascular (aorto-uni-iliac device) and open (femoro-femoral crossover) approach.ConclusionEndovascular surgery has revolutionized the management of such fistulae and we report an interesting case of a high-output iliac arteriovenous fistulae successfully treated with a hybrid vascular approach.

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Bifurcated Endograft Repair of Ilio-iliac Arteriovenous Fistula Secondary to Lumbar Diskectomy

Cited by 17 publications

References 18 publications

Endovascular repair of an ilio-iliac arteriovenous fistula following rupture of common iliac artery aneurysm with an aortic extension cuff in common iliac vein

Endovascular repair of an ilio-iliac arteriovenous fistula following rupture of common iliac artery aneurysm with an aortic extension cuff in common iliac vein

Iliac arteriovenous fistula presenting with ascites

Hybrid management of a spontaneous ilio-iliac arteriovenous fistula: a case report

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