Twenty Years of Experience in the Treatment of Spontaneous Aorto‐venous Fistulas in a Developing Country

Abstract

Spontaneous AVFs caused by aneurysmal rupture are not uncommon, and they require prompt surgical or endovascular treatment. Routine use of multislice CT in patients with acute aortic syndrome is probably the best way to the correct diagnosis of aorto-venous fistulas and planning of the optimal treatment.

Aorto-Left Renal Vein Fistula Caused by a Ruptured Abdominal Aortic Aneurysm

“…However, we performed a contrast-enhanced CT to make the details of anatomy of the ruptured aneurysm and the other intraoperative bleeding from the fistula. 5,8,9) In this case, preparation was made to insert an occlusion catheter through the femoral vein. However, it was not used because bleeding was successfully controlled manually.…”

“…5,8,9) There have been multiple recent reports on endovascular stent-grafts to treat aorto-caval fistulas caused by abdominal aortic aneurysms. 5,10) Endovascular treatment is an attractive modality because it is minimally invasive and causes less blood loss than open surgery. In this case, we thought that endovascular treatment could be difficult because of the fistula was located in the left renal vein.…”

“…Therefore, preoperative contrast-enhanced CT was useful in our case as well as previous reports mentioned. 1,4,5) It has been reported that approximately 3% of the population has retroaortic left renal vein. 6) In these people, the left renal vein does not become a landmark for renal artery during surgery because the vein is located dorsal to the aorta.…”

“…1) A caution is required to control bleeding from this type of fistula when an incision is made in the aortic aneurysm. 4,5) There are many reports in which an occlusion catheter was used in aorto-caval fistula cases to control indicated. When laparotomy was performed by abdominal midline incision, slightly bloody ascites was noted and hematomas of approximately 150 cc were observed proximal to the aneurysm and in the left retroperitoneal space.…”

Aortocaval Fistula: Is Endovascular Repair the Preferred Solution?

“…At the dawn of the endovascular age, most ACF had been repaired primarily in an open fashion and the literature accounted the surgical mortality to be as high as 16–66%. 4,5 However, after Beveridge et al 6 in 1998 reported the first endovascular repair of ACF, many have published reports of ACF describe endovascular management. We sought to review the contemporary outcomes and complications of both methods, present a successful case of open repair, and determine if endovascular repair was associated with improved outcomes.…”