Endovascular Stent-Graft Repair of Major Abdominal Arteriovenous Fistula:

Antoniou, George Α.; Koutsias, Stylianos; Karathanos, Christos; Sfyroeras, George S.; Vretzakis, George; Giannoukas, Athanasios D.

doi:10.1583/09-2725.1

Cited by 59 publications

(54 citation statements)

References 31 publications

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“…Vetrhus et al 27 proposed that endovascular repair is justified with only a small risk of endoleak. We found an endoleak rate of 50% which is much higher than that reported by Antonio et al 47 in 2009. Of the reported endoleaks, less than half resolved spontaneously and certainly this high proportion is connected to the concurrent ACF promoting patency of the aortovenous circuit.…”

Section: Discussioncontrasting

confidence: 63%

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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Section: Discussioncontrasting

confidence: 63%

Aortocaval Fistula: Is Endovascular Repair the Preferred Solution?

Orion

Beaulieu

Black

2016

Annals of Vascular Surgery

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“…Radiological studies are appropriate for the diagnosis 3 . Surgical treatment is generally complex, as the artery needs to be replaced with a prosthetic material, and sometimes the contiguous venous conduit has to be ligated, increasing the risk for pulmonary embolism, deep vein thrombosis, and posthrombotic syndrome 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Late complications such as pseudoaneurysms and arteriovenous fistulae are not frequent and can be missed during the first assessments. These complications are difficult to repair using conventional vascular surgery techniques, 2 but the endovascular techniques currently available offer less morbidity and mortality 3 . We report the case of a 17-year-old male patient who presented with an abdominal gunshot wound.…”

Section: Introductionmentioning

confidence: 99%

Endovascular repair of traumatic external iliac vessel pseudoaneurysm and arteriovenous fistulae

et al. 2013

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A 17-year-old male patient presenting with an abdominal gunshot wound and severe hypovolemic shock was initially operated and presented several injuries to the small bowel and cecum associated with severe hemorrhage. The patient had to be operated twice due to hypothermia, acidosis, and coagulopathy. In the late postoperative period, murmur and fremitus were observed. Angiography revealed a pseudoaneurysm associated with arteriovenous fistulae at the left external iliac vessels. Lesions were repaired with a stent graft placed in the external iliac artery, with a satisfactory outcome. Control computed tomography performed 6 months later evidenced artery integrity with closure of the fistulae. Endovascular therapy should be the preferred method in this type of vascular trauma complications.Keywords: iliac vessels; trauma; pseudoaneurysm; arteriovenous fistulae. ResumoUm paciente do sexo masculino com 17 anos de idade apresentando-se com ferimento abdominal por arma de fogo e choque hipovolêmico grave foi inicialmente operado e apresentava várias lesões no intestino delgado e ceco associadas a hemorragia grave. O paciente teve que ser operado duas vezes devido a hipotermia, acidose e coagulopatia. No período pós-operatório tardio, foram observados sopro e frêmito. Angiografia revelou um pseudoaneurisma associado a fístulas arteriovenosas nos vasos ilíacos externos ao lado esquerdo. As lesões foram tratadas mediante a colocação de stent na artéria ilíaca externa, com desfecho satisfatório. Tomografia computadorizada de controle realizada após 6 meses evidenciou integridade da artéria, com o fechamento das fístulas. O tratamento endovascular deve ser o método de escolha nesse tipo de complicação vascular traumática.Palavras-chave: vasos ilíacos; trauma; pseudoaneurisma; fístulas arteriovenosas.

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“…Abdominal 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.…”

Section: Introductionmentioning

confidence: 99%

“…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).…”

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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Endovascular Stent-Graft Repair of Major Abdominal Arteriovenous Fistula:

Abstract: Endovascular stent-graft repair of major abdominal arteriovenous fistula is a safe and effective treatment option, with good short- and midterm results. However, no long-term data exist, and larger series are required to draw solid conclusions regarding the outcomes of this method.

Cited by 59 publications

References 31 publications

Aortocaval Fistula: Is Endovascular Repair the Preferred Solution?

Aortocaval Fistula: Is Endovascular Repair the Preferred Solution?

Endovascular repair of traumatic external iliac vessel pseudoaneurysm and arteriovenous fistulae

Iliac arteriovenous fistula presenting with ascites

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