Iatrogenic aortocaval shunt treated by stent graft placement into the inferior vena cava

Abstract

Fifty six year old male sustained an injury to the abdominal aorta during his 1992 lumbar disc surgery with subsequent aortocaval shunt formation. In order to close the shunt, his abdominal aorta and both common iliac arteries were ligated and bilateral aortoiliac bypass was implanted. Postoperatively the patient remained asymptomatic for several years. Subsequently he developed arterial hypertension, his exercise capacity diminished and he complained of exertional dyspnea. Intraarterial DSA demonstrated filling of the occluded aortic segment from intercostal and lumbar arteries as well and a shunt between this segment and the inferior vena cava. The hemodynamic significance of the shunt was confirmed using catheterization. Attempted reduction of the shunt flow by intercostal arteries embolization was not successful. We were successful in closing the fistula using a custom-made stent graft. CTA performed 18 years after the procedure confirmed absence of the shunt and patent inferior vena cava. The patient is now asymptomatic 23 years after the original surgery.