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

Abstract

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.

Imaging in non Traumatic Emergencies: Acute Thrombosis of the Aorta and Pulmonary Embolism

“…Pulmonary embolism is a known complication of cardiac operations, and other major operations, but we found no descriptions of its coexistence with acute arterial thrombosis, except in the presence of patent foramen ovale [1], thrombi in the right cardiac ventricle and other arteriovenous connections [2] - the so--called "paradoxical embolism", which may be arterial (cerebrovascular stroke, coronary stroke) or venous (pulmonary embolism) 1--2 .…”

“…When it does occur [1][2][3][4] , according to the reports reviewed, the presentation tends to be dramatic, and management must be quick and involve various modalities of imaging and intensive medical and surgical treatment (anticoagulation and surgical/endovascular interventions) [1][2][3][4] . Pulmonary embolism is a known complication of cardiac operations, and other major operations, but we found no descriptions of its coexistence with acute arterial thrombosis, except in the presence of patent foramen ovale [1], thrombi in the right cardiac ventricle and other arteriovenous connections [2] - the so--called "paradoxical embolism", which may be arterial (cerebrovascular stroke, coronary stroke) or venous (pulmonary embolism) 1--2 .…”

“…Also, in many cases where traditionally surgery was used, angiography now serves as a therapeutic modality 2,5 .…”

Tratamento endovascular de aneurisma de aorta abdominal com fístula aorto-cava utilizando oclusor vascular concomitante a endoprótese bifurcada: relato de caso

“…Other reports only describe conventional treatment of the aneurysm with an endograft, without use of filters, achieving successful occlusion of the aortocaval fistula without reporting paradoxical embolism. [15][16][17] In view of the size of the aneurysm exerting pressure on the wall of the vena cava (which could make placement and removal of the temporary filter difficult) and since the occluder was available, we decided not to employ a filter. When occluding the fistula canal prior to introduction of the endograft, we therefore manipulated the lumen of the aneurysm as little as possible to avoid displacement of thrombi, and consequently PPE.…”

The Successful Treatment of an Ilio-Iliac Fistula and Aneurysms Affecting the Abdominal Aortic and Iliac Arteries via Endovascular Stent Graft Repair

“…they only account for 1% of abdominal aortic aneurysms. 1,2 Such fistulas classically present with a triad of high-output heart failure, a pulsatile abdominal mass with a bruit, and unilateral leg ischemia or venous congestion. 3 Therefore, the prompt repair of AVF is necessary to restore the patient's hemodynamics.…”