Endovascular Management of a Ruptured Iliac Aneurysm With an Inferior Vena Cava Fistula

Abstract

Aortocaval fistula is uncommon and often associated with a ruptured iliac or abdominal aortic aneurysm. It has a high mortality secondary to the aneurysmal rupture but also to a high output heart failure. Open surgery has been the standard; however, endovascular management has emerged with lower mortality. We present a patient with a ruptured iliac aneurysm and an inferior vena cava fistula successfully treated with an endograft with embolization of the right hypogastric artery. The patient arrested on induction and was resuscitated with aortic balloon inflation. Endovascular therapy can be safely used in the management of iliac/aortocaval fistula.

Endovascular Repair for Abdominal Aneurysm with Concomitant Aortoiliac Vein Fistula Diagnosed by Four-Dimensional Computed Tomography

“…The endoleak rate after endovascular management of an AAA with aortocaval fistula was estimated to be 15-50%, and the rate of fistula persistence was 9%. 8) Since the risk of endoleak in the present case was considered high, the aneurysmal sac was embolized with Impede-FX after stent graft insertion. Unfortunately, given the emergent situation, the median sacral artery was not identified preoperatively, and sac embolization was the first choice management to prevent an endoleak.…”

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

“…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.…”

“…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. 6 Survival is largely dependent on correct preoperative diagnosis and early surgical repair.…”

Abdominal aortic aneurysms ruptured to the vena cava: a case series and literature review

“…The high output heart failure contributes to this condition's high mortality. 3 Pulmonary embolism is another possible serious complication that can result from emboli originating within the aneurysm sac trespassing on the IVC. 10 Contrast-enhanced multislice angiotomography confirms the diagnosis.…”

“…1 Abdominal aortic aneurysm ruptured to the vena cava is a rare finding, with a reported incidence of less than 1% in ruptured abdominal aortic aneurysms (RAAA), but can lead to catastrophic hemodynamic effects with acute high-output heart failure. 2,3 Just a few cases have been reported in the literature and there is limited experience even at large centers. There is thus a lack of consensus on how to manage this disease.…”