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Case Reports
. 2020 Oct;102(8):e180-e182.
doi: 10.1308/rcsann.2020.0090. Epub 2020 May 21.

Aortocaval fistula, a potentially favourable complication of abdominal aortic aneurysm rupture in endovascular repair

S Greenfield  1 , G Martin  1 , M Malina  1 , N S Theivacumar  1
Affiliations
Case Reports

Aortocaval fistula, a potentially favourable complication of abdominal aortic aneurysm rupture in endovascular repair

S Greenfield et al. Ann R Coll Surg Engl. 2020 Oct.

Abstract

Endovascular aneurysm repair is an established treatment for ruptured abdominal aortic aneurysm. Primary aortocaval fistula is an exceedingly rare finding in ruptured abdominal aortic aneurysm, with a reported incidence of less than 1%. The presence of an aortocaval fistula used to be an unexpected finding in open surgical repair which often resulted in massive haemorrhage and caval injury. We present a case of ruptured abdominal aortic aneurysm with an aortocaval fistula that was successfully treated with percutaneous endovascular aneurysm repair under local anaesthesia. Despite a persistent type 2 endoleak the aneurysm sack shrank from 8.4cm to 4.8cm in 12 months. The presence of an aortocaval fistula may have depressurised the aneurysm, resulting in less bleeding retroperitoneally and may have promoted rapid shrinkage of the sac despite the presence of a persistent type 2 endoleak.

Keywords: Aortic aneurysm; Aortic rupture; Aortocaval fistula; Percutaneous EVAR; Type 2 endoleak.

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Figures

Figure 1
Figure 1
Preoperative computed tomography angiogram showing infrarenal abdominal aortic aneurysm, aortocaval fistula and adjacent haematoma.
Figure 2
Figure 2
Preoperative computed tomography angiogram with three-dimensional reconstruction showing abdominal aortic aneurysm (arrow demonstrates pathway of blood diversion through aortocaval fistula).
Figure 3
Figure 3
Thirty-day postoperative computed tomography angiogram showing stented abdominal aortic aneurysm, type II endoleak and persistent aortocaval fistula.
Figure 4
Figure 4
Thirty-day postoperative computed tomography angiogram with three-dimensional reconstruction showing stented abdominal aortic aneurysm, type II endoleak and persistent aortocaval fistula (ACF; arrows represent retrograde blood flow through the inferior mesenteric artery into the aortic sac and subsequent diversion into the inferior vena cava).
Figure 5
Figure 5
Axial view of computed tomography angiogram showing aortic sac and persistent aortocaval fistula and type 2 endoleak.
See this image and copyright information in PMC

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