Emergency Endovascular Repair of Aortocaval Fistula-A Single Center Experience

Akwei, Solomon; Altaf, Nishath; Tennant, William G.; MacSweeney, Shane T.; Braithwaite, B. D.

doi:10.1177/1538574411407087

Cited by 38 publications

(40 citation statements)

References 16 publications

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“…This may have been partially because of delays in diagnosis but it also illustrates the severity and acuity of this condition. 7 This approach has the potential benefit of much less blood loss as the fistula is not repaired directly. Also, there is no need for aortic cross-clamping and the anesthetic requirements can be much less than with the open surgical approach.…”

Section: Discussionmentioning

confidence: 99%

Delayed Endovascular Aneurysm Repair for Aorto-caval Fistula with Correction of Physiologic and Metabolic Abnormalities: A Disease Process Review

Madsen

Franz

2015

Annals of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Delayed Endovascular Aneurysm Repair for Aorto-caval Fistula with Correction of Physiologic and Metabolic Abnormalities: A Disease Process Review

Madsen

Franz

2015

Annals of Vascular Surgery

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“…10 A wrong or clinically missed diagnosis contributes to poor operative outcomes, especially in the typical elderly patient who may already be under hemodynamic stress. 13 Open surgery and endovascular repair are the treatment options. Supraceliac control of the aorta via an elastic loop is essential for controlling excessive bleeding, especially in an aneurysm that has a short proximal…”

Section: Discussionmentioning

confidence: 99%

Surgical Repair of a 13-cm Infrarenal Abdominal Aortic Aneurysm with Aortocaval Fistula in a 63-Year-Old Tuba Player

Bitargil¹,

Bektaş²,

Ömeroğlu³

et al. 2019

Texas Heart Institute Journal

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Infrarenal abdominal aortic aneurysm with aortocaval fistula, a rare condition, can be fatal without prompt intervention. The clinical symptoms are complex and varied, so diagnosis is typically confirmed by use of contrast-enhanced multidetector computed tomography. We report our surgical repair of a 13-cm-diameter infrarenal abdominal aortic aneurysm and aortocaval fistula in a 63-year-old orchestral tuba player who had 2 classic symptoms of the condition. The unruptured aneurysm and fistula were complicated by acutely angled vessels, so we performed surgery rather than endovascular repair. The patient recovered fully and was discharged from the hospital. This infrarenal aneurysm with aortocaval fistula is perhaps the largest to have been treated successfully by means of open surgery. In addition to our patient's case, we discuss the history and treatment considerations of this rare combined condition.

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“…However, one was 3 months postoperative and may have been unrelated to the surgery. 27 Furthermore, Akwei et al 38 reported 4 endovascular cases of which 3 died, but all three of those deaths had been admitted to the hospital as many as 6 days before the diagnosis of the ACF. Thus, delay in diagnosis and treatment likely played a factor in their outcome, and these patients were not likely to fare better with open surgery.…”

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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Emergency Endovascular Repair of Aortocaval Fistula-A Single Center Experience

Abstract: Our experience illustrates the importance of early diagnosis and management of ACF. Even in experienced hands, the management of spontaneous ACF associated with AAA is challenging. Endovascular surgery may still have a role in improving outcomes in these patients.

Cited by 38 publications

References 16 publications

Delayed Endovascular Aneurysm Repair for Aorto-caval Fistula with Correction of Physiologic and Metabolic Abnormalities: A Disease Process Review

Delayed Endovascular Aneurysm Repair for Aorto-caval Fistula with Correction of Physiologic and Metabolic Abnormalities: A Disease Process Review

Surgical Repair of a 13-cm Infrarenal Abdominal Aortic Aneurysm with Aortocaval Fistula in a 63-Year-Old Tuba Player

Aortocaval Fistula: Is Endovascular Repair the Preferred Solution?

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