Abstract
Endovascular aortic aneurysm repair (EVAR) is a valid treatment for patients with abdominal aortic aneurysm with aortocaval fistula. However, an endoleak can be caused by persistent communication between the aneurysm and the inferior vena cava. We present a case of impending rupture due to spontaneous obstruction of an aortocaval fistula after EVAR. Spontaneous obstruction of an aortocaval fistula is rare; however, when occurs, it will cause an endoleak, followed by dilatation or impending rupture of the abdominal aortic aneurysm. EVAR alone for aortocaval fistula will sometimes not be adequate if the type II endoleak is patent.
Highlights
Endovascular aortic aneurysm repair (EVAR) is a valid treatment for patients with abdominal aortic aneurysm with aortocaval fistula
We report a case of an abdominal aortic aneurysm (AAA), in which rapid dilatation of the aneurysm sac associated with spontaneous obstruction of the aortocaval fistula (ACF) was observed after EVAR
computed tomography (CT) recorded in the arterial and delayed phases revealed rapid dilatation of the aneurysm sac during the previous 2 months and manifestation of the type II endoleak via the inferior mesenteric artery (IMA) from the meandering mesenteric artery (“dead-end” endoleak) by spontaneous obstruction of the ACF (Fig 2)
Summary
An 85-year-old man with a history of smoking, hypertension, and chronic obstructive pulmonary disease had presented with acute abdominal pain and was transferred to the emergency room of our hospital. He had hepatorenal failure and right-sided heart failure. CT recorded in the arterial and delayed phases revealed rapid dilatation of the aneurysm sac during the previous 2 months (maximum transverse diameter had increased from 61 to 76 mm) and manifestation of the type II endoleak via the IMA from the meandering mesenteric artery (“dead-end” endoleak) by spontaneous obstruction of the ACF (Fig 2). The patient had an uneventful recovery and was discharged 20 days after surgery
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