AORTOCAVAL FISTULA ASSOCIATED WITH ABDOMINAL AORTIC ANEURYSM: CASE REPORT

Giulia Marchini Bertolacini, Gláucia Maruyama Ferreira, Giulia Garcia Mendes, Leonardo Lourenço Zukeran, Guilherme Marum Olmedo MD, Henrique Jose Pereira de Godoy MD, Fernando Reis Neto MD and Jose Maria Pereira De Godoy MD, PhD*

ABSTRACT

The aortocaval fistula (ACF) related to abdominal aortic aneurysm (AAA) is a rare event. The objective of the present study is to report the approach and evolution of a patient with an aortocaval fistula. The patient, a 78-year-old male hypertensive, pain in the right iliac fossa, irradiating to the right lower limb, associated with tingling on walking and edema, and dyspnea on effort. After an abdominal CT scan, an infrarenal abdominal aortic aneurysm with an aortocaval fistula was found. On physical examination, a pulsatile abdominal mass was found. After angiotomography, the diagnosis of aneurysm was confirmed, and the patient underwent endovascular treatment with an AFX stent graft. The procedure was successful upon verification with aortography. Eearly imaging control was performed by angiotomography, in which the presence of a type II endoleak was found, and embolization of the inferior mesenteric artery branch was performed with ischemic colitis during clinical treatment. Although the immediate postoperative period was corrected, the patient did not return for follow-up angiotomography. In control after six months the patient sought the service again with a complaint of abdominal pain for 15 days, accompanied by the appearance of collateral circulation for 30 days. At the site of origin, an abdominal CT scan was performed that found an aortocaval fistula due to a possible type III endoleak. An endovascular procedure was indicated for the introduction of a straight stent graft for correction, which occurred successfully. Aorto caval fistula is a rare complication where the approaches suggested in the literature are open and endovascular procedures and more recently endovascular procedures have shown lower mortality where endoleaks are the most common intercurrence.

Keywords: Aneurysm, Fistula, Abdominal, Aortic, Endoleak.