Iliocaval arteriovenous fistula presenting with multiple organ failure

Lim, RP; Stella, Damien; Dowling, Richard; Wa, Campbell; Hebbard, GS

doi:10.1111/j.1440-1673.2006.01606.x

Cited by 8 publications

(9 citation statements)

References 11 publications

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“…Arteriovenous fistulous communication between the common iliac arteries and inferior vena cava (iliocaval fistula) is extremely rare (approximately <1%) compared to fistulous communications between the aorta and inferior vena cava (Fig. 1) [1]. They generally arise from prior trauma, aneurysmal rupture or endovascular repair in that region.…”

Section: Discussionmentioning

confidence: 99%

Iliocaval fistula with high output cardiac failure

Ismail

Meter

2019

Radiology Case Reports

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Fistulous communications between the common iliac arteries and inferior vena cava are very uncommon and usually occur as a result of trauma, aneurysmal rupture, or endovascular repair. They can present with signs of high output cardiac failure including hypotension, venous congestion, and pulmonary hypertension. This case outlines the utility of CTA in diagnosing iliocaval fistulas and the importance of considering this diagnosis in a patient with signs of right heart strain and high output cardiac failure.

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Section: Discussionmentioning

confidence: 99%

Iliocaval fistula with high output cardiac failure

Ismail

Meter

2019

Radiology Case Reports

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“…Recently, CT play an important role in identifying arteriovenous fistula as a easily available and non-invasive tool after Cheung et al (8) firstly described arteriovenous fistula that was diagnosed by CT in 1987. Important radiologic features include iliac artery aneurysm, vena caval dilatation, and increased density of IVC similar to that of the aorta and visualization of the fistula (2,8,9). The CT findings of our patient showed that iliac artery aneurysm including thrombi and increased density of IVC similar to that of iliac artery in arterial phase.…”

Section: Discussionmentioning

confidence: 99%

“…Such fistula classically present with a triad of high-output heart failure, pulsatile abdominal mass with a bruit and unilateral leg ischemia or venous congestion (2). Paradoxical pulmonary embolism related with arteriovenous fistula is exceedingly rare, but this situation can be developed and is very serious complication of arteriovenous fistula (3).…”

Section: Introductionmentioning

confidence: 99%

Iliocaval Fistula Presenting with Paradoxical Pulmonary Embolism Combined with High-Output Heart Failure Successfully Treated by Endovascular Stent-Graft Repair: Case Report

Koh

Kim

et al. 2014

J Korean Med Sci

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A 51-yr-old man presented exertional dyspnea as a consequence of iliocaval fistula combined with paradoxical pulmonary embolism and high-output heart failure. Endovascular stent-graft repair was performed to cover iliocaval fistula and restore the heart function. After the procedure, dyspnea was improved and procedure related complication was not seen. A 6-month follow-up computed tomography showed regression of pulmonary thromboembolism and well-positioned stent-graft without graft migration, aortacaval communication or endoleak. Stent graft implantation should be considered an alternative of open repair surgery for treament of abdominal arteriovenous fisula, especially in patient with high risk for surgery.

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“…Aortic angiography used to be the investigation of choice to confirm the clinical suspicion of aortocaval or iliocaval fistula [10]. For the past two decades, CT with intravenous contrast has been used more frequently for the diagnosis of aortocaval or iliocaval fistula [8,11]. Important radiological diagnostic features include aortic or iliac artery dilatation, vena caval dilatation, increased density of the IVC similar to that of the aorta and visualization of the fistula [11].…”

Section: Discussionmentioning

confidence: 99%

Simultaneous endovascular repair of an iatrogenic carotid-jugular fistula and a large iliocaval fistula presenting with multiorgan failure: a case report

et al. 2012

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IntroductionIliocaval fistulas can complicate an iliac artery aneurysm. The clinical presentation is classically a triad of hypotension, a pulsatile mass and heart failure. In this instance, following presentation with multiorgan failure, management included the immediate use of an endovascular stent graft on discovery of the fistula.Case presentationA 62-year-old Caucasian man presented to our tertiary hospital for management of iatrogenic trauma due to the insertion of a central venous line into his right common carotid artery, causing transient ischemic attack. Our patient presented to a peripheral hospital with fever, nausea, vomiting, acute renal failure, acute hepatic dysfunction and congestive heart failure. A provisional diagnosis of sepsis of unknown origin was made. There was a 6.5 cm×6.5 cm right iliac artery aneurysm present on a non-contrast computed tomography scan. An unexpected intra-operative diagnosis of an iliocaval fistula was made following the successful angiographic removal of the central line to his right common carotid artery. Closure of the iliocaval fistula and repair of the iliac aneurysm using a three-piece endovascular aortic stent graft was then undertaken as part of the same procedure. This was an unexpected presentation of an iliocaval fistula.ConclusionOur case demonstrates that endovascular repair of a large iliac artery aneurysm associated with a caval fistula is safe and effective and can be performed at the time of the diagnostic angiography. The presentation of an iliocaval fistula in this case was unusual which made the diagnosis difficult and unexpected at the time of surgery. The benefit of immediate repair, despite hemodynamic instability during anesthesia, is clear. Our patient had two coronary angiograms through his right femoral artery decades ago. Unusual iatrogenic causes of iliocaval fistulas secondary to previous coronary angiograms with wire and/or catheter manipulation should be considered in patients such as ours.

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Iliocaval arteriovenous fistula presenting with multiple organ failure

Cited by 8 publications

References 11 publications

Iliocaval fistula with high output cardiac failure

Iliocaval fistula with high output cardiac failure

Iliocaval Fistula Presenting with Paradoxical Pulmonary Embolism Combined with High-Output Heart Failure Successfully Treated by Endovascular Stent-Graft Repair: Case Report

Simultaneous endovascular repair of an iatrogenic carotid-jugular fistula and a large iliocaval fistula presenting with multiorgan failure: a case report

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