Endovascular Treatment of Major Abdominal Arteriovenous Fistulas

Abstract

Forty-eight articles were reviewed totaling a number of 54 patients including our own. The most common fistula site was the aortocaval segment. Aortic stent grafts were used in 78% of patients. Technical success was 94%. Intraoperative mortality was 0% with a 90-day mortality of 10%, half of which were not related to the primary pathology. Of the successful procedures, 12% of patients had major complications. One died before reintervention. All others had uneventful recoveries; 21% had minor complications treated conservatively. The majority of authors were in favor of this treatment modality.

Percutaneous fenestrated endovascular aortic graft treatment of aortocaval fistula with aortic pseudoaneurysms secondary to penetrating trauma

“…In cases of acute rupture of aneurysms into the inferior vena cava, these hemodynamic changes are profound and can lead to cardiopulmonary collapse and death when unrecognized. 14,15 However, in chronic ACFs, as in this young patient, cardiac remodeling takes place with cardiomegaly and left ventricular hypertrophy to support the increased preload. 16 After correction of the ACF, positive heart remodeling takes place after an acute period of increased afterload effects and a decreased ejection fraction, as occurred in this patient.…”

Successful surgical repair of an ilio-iliac arteriovenous fistula associated with a ruptured common iliac artery aneurysm

“…However, its long-term performance is still unknown. In a systematic review, the longest follow-up time after endovascular repair was 24 months, and the mean follow-up time was only 9 months [15] . Endovascular repair also carries the risk of type 2 endoleak due to venous bleeding through the AVF and consequent expansion of the aneurysm.…”

Multi-organ failure secondary to an aortocaval fistula-when should it be suspected?

“…The use of these newer techniques in ACF repair has gained favour in more recent years and in selected cases appears to be associated with high success rates although the rarity of the condition and reporting bias for both strategies limit any conclusions from current data regarding a survival advantage [21] . Notwithstanding the limitation of data, a recent systematic review of case reports of endovascular repair of major abdominal arteriovenous fistulas presented a 94% technical success rate and 0% and 10% intra-operative and 90-day mortality respectively [22] .…”