Endovascular Therapy for Spontaneous Ilio-Iliac Arteriovenous Fistula Due To Iliac Artery Aneurysm Rupture With Multi-Organ Dysfunction

Abstract

<jats:p> Iliac artery aneurysms can rarely present with rupture into adjacent iliac vein resulting in arteriovenous fistula leading to acute cardiac failure or multi-organ failure. End-organ damage can be reversed with timely diagnosis and intervention. Endovascular therapy is an attractive option to treat this pathology besides allowing for a quick recovery and mitigating the risk of mortality associated with open surgical treatment options. We report treatment of this pathology with Endovascular repair with preservation of ipsilateral hypogastric artery flow using an iliac branch graft device. The postoperative course was complicated by type 3 endoleak due to the separation of components between iliac branch graft and aortic stent graft with resultant recurrence of the fistula. Additional endovascular techniques, including placement of a venous stent and stent grafts to bridge the components, was used to treat the endoleak. We present this report due to the unique nature of the recurrent arteriovenous fistula, technical complexity, and resultant multi-organ dysfunction. </jats:p>

Hepatorenal syndrome from an ilio-iliac arteriovenous fistula: A rare complication from an endoleak

“…The advent of iliac branch devices offers an alternative means for successful ilio-iliac AVF repair with preservation of pelvic perfusion. 1 Our patient's AVF was either due to aneurysm enlargement and adjacent erosion, or an iatrogenic injury during wire manipulation at the time of initial repair. The failure to use a noncompliant balloon led to improper stent-graft apposition to the gate of the branch piece resulting J o u r n a l P r e -p r o o f in the type III endoleak.…”

“…In recent years, the management of iliac aneurysms and related pathologies (ie, AVF) has shifted from open to endovascular repair owing to the lower morbidity and mortality. 1 , 5 Similar to the repair of common iliac aneurysms, the endovascular repair of ilio-iliac AVFs was initially approached with embolization of the internal iliac artery, followed by iliac stent exclusion. The advent of iliac branch devices has offered an alternative method for successful ilio-iliac AVF repair with preservation of pelvic perfusion.…”

“…The advent of iliac branch devices has offered an alternative method for successful ilio-iliac AVF repair with preservation of pelvic perfusion. 1 …”

“…In such cases, aneurysm progression results in erosion into an adjacent vein creating an arteriovenous shunt. 1 The anatomic proximity of the iliac vessels makes iliac artery aneurysms susceptible to fistula formation. These ilio-iliac arteriovenous fistulas (AVF) are most commonly caused by trauma, although spontaneous occurrences have been reported.…”

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

“…Two cases were iatrogenic ilioiliac fistulas after lumbar surgery 9,10 and 1 case after prostate surgery. 11 One case was secondary to a ruptured iliac aneurysm 12 and another secondary to tumor infiltration. 13 Six of 11 cases were ACFs, 5 were secondary to an AAA (2 ruptured), 14 -18 and 1 was a delayed fistula secondary to a penetrating trauma.…”