Work

A successful case of abdominal aortic aneurysm complicated by abdominal aortocaval fistula by endovascular aneurysm repair

Year: 2025

Type: article

Abstract: INTRODUCTION: An aortocaval fistula (ACF) associated with an abdominal aortic aneurysm (AAA) is relatively rare and causes various clinical symptoms. No consensus has been reached regarding surgical treatment for high-risk patients. PRESENTATION OF CASE: We report the case of a 76-year-old male with an AAA-inferior vena cava (IVC) fistula, incidentally diagnosed during examination for chronic heart failure and renal dysfunction. Contrast-enhanced computed tomography (CT) revealed IVC compression by a saccular AAA (56.6 mm × 73.7 mm), contrast agent inflow into the IVC, and a large fistula. The patient underwent emergency endovascular aneurysm repair (EVAR) to prevent rupture and reduce shunt volume. The postoperative course was uneventful. Follow-up CT showed shrinkage of the AAA diameter despite a slight residual shunt into the IVC. DISCUSSION: ACF is a relatively rare comorbidity of AAA. The standard surgical intervention for AAA complicated by ACF involves abdominal aortic graft replacement and fistula closure. However, no consensus exists regarding the optimal surgical approach for high-risk patients. Our surgical intervention was selected based on the patient's condition, as well as the ACF and AAA characteristics. Considering the potential perioperative risks associated with renal dysfunction and chronic heart failure, we opted to perform EVAR. EVAR allowed for a safe and reliable procedure for managing AAA complicated by ACF, improving the patient's condition and preventing rupture. CONCLUSION: This case provides valuable insight into the successful emergency EVAR treatment for a high-risk patient experiencing chronic heart failure and acute kidney injury due to increased preload from an ACF.

Source: International Journal of Surgery Case Reports

DOI: 10.1016/j.ijscr.2025.111806

Authors: Kosuke Tsumura, Masateru Uchiyama

Institutions: Kawasaki Saiwai Hospital, Teikyo University

Language: English

Topic: Aortic aneurysm repair treatments

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,090