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      Aortocaval Fistula: A Rare Cause of Venous Hypertension and Acute Renal Failure

      case-report

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          Abstract

          Spontaneous rupture of abdominal aortic aneurysm into the inferior vena cava is rare and is associated with high mortality and morbidity. The clinical presentation can be variable and thus the diagnosis can be difficult. It can present with symptoms and signs of an abdominal emergency, venous hypertension, or systemic hypoperfusion. The traditional method of repair has been open surgery which is associated with high rate of complications. We report a case of aortocaval fistula (ACF) presenting with acute renal failure and heart failure, which was treated successfully with a novel, endovascular approach.

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          Endovascular stent-graft repair of major abdominal arteriovenous fistula: a systematic review.

          Giorgos Sfyroeras, Georgios Vretzakis, George Antoniou … (2009)
          To evaluate the outcomes of endovascular stent-graft repair of major abdominal arteriovenous fistulas. The English literature was systematically searched using the MEDLINE electronic database up to January 2009. All reports on endovascular stent-graft repair of major abdominal arteriovenous fistula were considered. Our experience of abdominal arteriovenous fistula was involved in the data analysis. The primary outcome measures were technical success and perioperative, 30-day, and overall mortality. Data for the final analysis were extracted from 21 papers reporting on 22 patients and from the medical records of a patient treated at our institution. The most common causal associations of these fistulae were the presence of an aortoiliac aneurysm and previous endovascular aneurysm repair, accounting for 56% and 13% of all associations, respectively. The technical success rate was 96% (22/23). No perioperative or 30-day mortality was noticed during a mean follow-up of 9 months. The most common procedure-related complication was type II endoleak, which was found in 22% (5/23) of the patients. This event was either self limiting or required minimal percutaneous intervention. Endovascular stent-graft repair of major abdominal arteriovenous fistula is a safe and effective treatment option, with good short- and midterm results. However, no long-term data exist, and larger series are required to draw solid conclusions regarding the outcomes of this method.
          Article 0 comments Cited 11 times – based on 0 reviews     Review now
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            Paradoxical pulmonary embolism with spontaneous aortocaval fistula.

            Paola De Rango, Gianbattista Parlani, Enrico Cieri … (2012)
            Paradoxical pulmonary embolisms are uncommon emergencies and can occur as a consequence of an aortocaval fistula due to unrecognized dislodgement of thrombus from aortic sac into pulmonary circulation. This study reviewed current literature and therapeutic options in this emergency condition requiring prompt management and repair. Literature was systematically searched for paradoxical pulmonary embolism associated with aortocaval rupture. Eight published cases were identified. However, many other paradoxical pulmonary emboli could have remained undiagnosed due to challenging clinical presentation. Symptoms of high-output cardiac failure and respiratory distress in the presence of large aortoiliac aneurysm and venous hypertension are findings of a possible major abdominal arteriovenous fistula with paradoxical pulmonary embolism. Successful treatment depends on prevention of new embolism and proper management of perioperative hemodynamics and massive bleeding during fistula repair. Endovascular procedures have been recently used as useful tools in this field. Cava filter placement may be a first step to prevent further thrombus dislodgements during aortocaval repair. Immediate subsequent aortic stent-grafting can allow repair of aortocaval communication and exclusion of the abdominal aortic aneurysm from circulation with successful reversal of altered hemodynamic features. However, experience (especially in the long-term) is limited. Paradoxical pulmonary embolism from aortocaval fistula represents an extremely rare but true clinical emergency with high fatality rate. Recent advances in diagnostic technology and endovascular techniques can substantially improve outcomes of the disease. Clinical competence in early detection and diagnosis is essential for appropriate emergent management. Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.
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              Aortocaval fistula as a complication of abdominal aortic aneurysms.

              J L Ehrenhaft, L A Sharzer, Andrew Baker (1972)
              Article 0 comments Cited 7 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Surg
                Journal ID (iso-abbrev): Case Rep Surg
                Journal ID (publisher-id): CRIM.SURGERY
                Title: Case Reports in Surgery
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-6900
                ISSN (Electronic): 2090-6919
                Publication date (Print): 2012
                Publication date (Electronic): 30 December 2012
                Volume: 2012
                Electronic Location Identifier: 487079
                Affiliations
                1Division of Nephrology and Hypertension, Department of Internal Medicine at UTMB, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
                2Holzer Clinic, 100 Jackson Pike, Gallipolis, OH 45631, USA
                Author notes
                *Chandandeep Takkar: chtakkar@ 123456utmb.edu

                Academic Editors: C. Barnett, A. A. Saber, and B. Tokar

                Author information
                https://orcid.org/0000-0002-8157-0173
                https://orcid.org/0000-0002-3880-4536
                Article
                DOI: 10.1155/2012/487079
                PMC ID: 3546445
                PubMed ID: 23346449
                SO-VID: 2576bf45-0243-42fa-b158-d0ef3b486c5a
                Copyright © Copyright © 2012 Chandandeep Takkar et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 28 November 2012
                Date accepted : 17 December 2012
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Data availability:
                ScienceOpen disciplines: Surgery

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