Endovascular Treatment of an Aneurysm Rupture into the Inferior Vena Cava Olga Xiropotamou 1 , George Kouvelos 2 , Michalis Peroulis 2 , Vasilios Bouris 2 , Maria Zeygara 1 , Thomas Vadivoulis 1 , Maria Argyropoulou 1 and Miltiadis Matsagkas 2 1 Department of Radiology, School of Medicine, University of Ioannina, Ioannina, Greece 2 Department of Surgery- Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece Corresponding author: Miltadis I Matsagkas, Professor of Vascular Surgery, Department of Surgery Vascular Surgery Unit Medical School, University of Ioannina, Ioannina University Campus, S. Niarchos Avenue, 45110, Ioannina, Greece, Tel: +30 26 5100 7422; Fax: +30 26 5103 3379; Email: mimats@cc.uoi.gr; milmats@gmail.com Received date: February 19, 2016; Accepted date: March 22, 2016; Published date: March 31, 2016 Introducton Major abdominal arteriovenous fstulas are defned as anomalous communicatons between the aorta, iliac or renal arteries and the inferior vena cava (IVC), iliac or renal veins. Aortocaval fstula (ACF) is one of the less well-recognized complicatons occurring in < 1% of all abdominal aortc aneurysms (AAAs) and 3% - 7% of all ruptured AAAs [1]. The overall mortality in patents with AAA and associated ACF has been reported as high as 67% [2]. This high rate could be partally atributed to the excessive blood fow through the fstula, usually resultng to central venous hypertension, refractory congestve heart failure and mult organ failure [1-3]. ACF can also present in combinaton with retroperitoneal rupture, having a much worse prognosis [2, 3]. Aortocaval fstula, if not treated, is rapidly fatal and repair of the arteriovenous communicaton is mandatory for resttuton of a normal hemodynamic status. Herein we present a case of aortocaval fstula in a ruptured AAA (rAAA), focusing on diagnosis and treatment optons. Case Report A 65 years old male with a history of hypertension and tobacco use presented to the emergency department complaining for an acute abdominal pain radiatng to the lower spine. His conditon was stable (blood pressure 135 / 80 mmHg, heart rate 100 beats / min, respiratory rate 24 / min). Abdominal examinaton revealed a pulsatle mass and a contnuous audible bruit with systolic accentuaton over the central abdomen. No shortness of breath was notced. Laboratory tests were normal. Urgent computed tomography (CT) angiography, revealed an infrarenal AAA 9, 3 cm in diameter. During the arterial phase, there was a rapid contrast flling of the inferior vena cava, indicatng the presence of a dynamic fstula from the right lateral wall of the aneurysmal sac (Figure 1). Figure 1 Computed tomography angiography (axial images and coronal view) showing a wide, high – fow aortocaval fstula (fstulous tract, white arrow) (A), located above the aortc bifurcaton (B). An endovascular repair of the rAAA was decided. Anatomical characteristcs are presented in Table 1. An endograf with suprarenal fxaton was chosen to accomplish beter appositon to the highly angulated proximal aortc neck. Afer surgical cut down on both femoral arteries, the intraoperatve aortogram confrmed the presence of the ACF without retroperitoneal leak. An Endurant II (Medronic Cardiovascular, Santa Rosa, CA, USA) aortc bifurcated stent graf was deployed. The total operatng tme was 90 minutes. The fnal aortogram revealed no endoleaks, exclusion of the aneurysm sac and complete sealing of the ACF. Table 1 Anatomical characteristc of the ruptured AAA. Maximum AAA diameter 90 mm Aortic neck diameter 26.8 mm - 27.1 mm Aortic neck length 30.1 mm Suprarenal angle 49.4° Infrarenal angle 87.4° Right common iliac artery 30 mm Left common iliac artery 13.5 mm AAA: Abdominal Aortic Aneurysm The patent was admited in intensive care unit (ICU) and was transferred to the wards the day afer. The postoperatve Case Report iMedPub Journals http://www.imedpub.com/ Journal of Vascular and Endovascular Surgery Vol.1 No.1:4 2016 © Copyright iMedPub | This article is available from: http://vascular-endovascular-surgery.imedpub.com/archive.php 1 DOI: 10.21767/2573-4482.100004