Aorto-left Renal Vein Fistula Research Articles

Massive Endoleak From Retro-Aortic Left Renal Vein Fistula

A 64 year old non-smoking man without concomitant disorders was admitted with sudden onset of abdominal pain and hypotension. Computed tomography angiography (CTA) showed a 90 mm infrarenal abdominal aortic aneurysm (AAA) with free retroperitoneal fluid. The AAA was treated as a rupture by endovascular repair. After re-evaluation of the pre-operative CTA, the retroperitoneal fluid was considered secondary to renal oedema caused by aorto-left renal vein (LRV) fistula. (A) Post-operative CTA showed a massive endoleak (arrow) through the fistula confirmed by phlebography (B, arrows). This was resolved by implanting a self expandable stent graft in the LRV.Image 1

Complete Endovascular Management of a Spontaneous Aorto-left Renal Vein Fistula Caused by Ruptured Abdominal Aortic Aneurysm Under Local Anaesthetic: A Case Report

Complete Endovascular Management of a Spontaneous Aorto-left Renal Vein Fistula Caused by Ruptured Abdominal Aortic Aneurysm Under Local Anaesthetic: A Case Report

Complete Endovascular Management of a Spontaneous Aorto-left Renal Vein Fistula Caused by Ruptured Abdominal Aortic Aneurysm Under Local Anaesthetic: A Case Report

Introduction Aorto-left renal vein fistulae (ALRVF) are extremely rare, with few cases reported in the literature. We report the first case of complete endovascular management of a spontaneous ALRVF secondary to a ruptured abdominal aortic aneurysm (AAA) under local anaesthetic. Report A 73-year-old man presented with acute left loin pain and haematuria. A CT scan demonstrated an infra-renal AAA, rupturing posteriorly into a retroaortic left renal vein. Given aneurysm suitability and patient factors, this was treated by endovascular management. Discussion Open operations in such cases are associated with high morbidity and mortality. Endovascular stenting provides a lifesaving alternative.

Multidetector computed tomography findings of abdominal aortic aneurysm and its complications: a pictorial review

Abdominal aortic aneurysms (AAAs) are defined as abnormal dilatation of the abdominal aorta and are potential to catastrophic complications. With the advent of multidetector computed tomography (MDCT), this diagnostic modality has virtually replaced conventional angiography in many circumstances and has become an integral part of the evaluation of AAA. Its ability to assess the peri-aortic soft tissue and the exact extension of aneurysm as well as its excellent vascular opacification and multiplanar reconstruction make computed tomography angiography the best suited imaging modality for not only detecting AAA but also evaluating its various complications. In this pictorial essay, we intend to demonstrate the spectrum of MDCT findings in AAA and its various consequences including impending rupture, contained rupture, rupture, aorto-caval fistula, aorto-left renal vein fistula, aorto-enteric fistula, and infection. Familiarity with the characteristic imaging features of AAA is essential for clinical radiologists and also referring physicians for the prompt diagnosis of life-threatening complications.

Aorto-Left Renal Vein Fistula Caused by a Ruptured Abdominal Aortic Aneurysm

Retroaortic left renal vein is a malformation in which the left renal vein courses dorsal to the abdominal aorta. In patients with abdominal aortic aneurysm, an aorto-left renal vein fistula can form if the left renal vein is sandwiched between the aneurysm wall and lumbar vertebrae. The patient was an 84-year-old man with lower back pain. We performed a contrast-enhanced computed tomography (CT), although renal dysfunction was noted. The CT showed a ruptured juxta-renal abdominal aortic with aorto-left renal vein fistula. This clinical condition can cause severe renal dysfunction, in spite of which an enhanced contrasted CT scan would be extremely informative preoperatively.

Aorto-left renal vein fistula is a rare complication of abdominal aortic aneurysm with unique clinical presentation

Spontaneous aorto-left renal vein fistulas (ALRVF) are extremely rare, with only 30 cases presented in the literature. In the majority of the reported cases, the fistula involved an anomalous retroaortic left renal vein. In some aspects, the clinical findings differ from those of aortocaval fistulas, often making the correct diagnosis difficult and contributing to the delay in treatment. In this article, we present 2 such cases, review previously reported data, and discuss clinical features and treatment options of this rare condition.

Post-traumatic giant fistula between the aorta and the left renal vein: A case report

A unique case of post-traumatic aorto-left renal vein fistula (ALRVF) is presented. Some specific features of diagnosis and treatment of post-traumatic and postaneurysm ALRVF are discussed. The importance of careful planning of the operative strategy is emphasized because substantial blood loss may lead to serious intraoperative complications and frequently necessitates autohemotransfusion. The 10-year follow-up confirmed that direct reconstruction was the appropriate procedure, with no indications that an endovascular procedure would have been preferable. Direct reconstruction may also be valuable in treating postaneurysm ALVRF.

Retroaortic left renal vein fistula masquerading as pelvic congestion syndrome: Case report

This case study shows how aorto-left renal vein fistula in a female can present with left-sided pelvic pain secondary to ovarian vein reflux, a symptom of pelvic congestion syndrome, next to typical features such as epigastric and back pain.

Endoluminal repair of an acute aorto-left renal vein fistula

A 64-year-old man with hypertension presented with acute left-sided abdominal and chest pain. Notable laboratory studies included a creatinine of 2.6 mg/dL. Noncontrast computed tomography (CT) scan revealed an 8.5-cm infrarenal abdominal aortic aneurysm (AAA) with perianeurysmal stranding extending into the left renal space and a large retroaortic left renal vein. In the operating room, percutaneous transfemoral access was obtained. Aortography revealed extravasation of contrast as well as brisk filling of the inferior vena cava via a fistula to a retroaortic left renal vein (Fig, A). Exclusion of the aneurysm and the aorto-left renal vein fistula (ALRVF) was achieved after successful deployment of a 26 × 160 mm Gore Excluder bifurcated endoprosthesis with a 14.5 × 140 mm contralateral limb (Fig, B) (W.L. Gore & Associates Inc, Falstaff, Ariz). After complete exclusion of the aneurysm, the patient's hemodynamics improved immediately, with a decrease in the central venous pressure (CVP) from 42 to 20 mm Hg, an increase in blood pressure from 95/40 to 135/60, and a decrease in heart rate from 100 to 84 beats per minute. Percutaneous mechanical closure devices (Prostar XL, Perclose; Abbott Laboratories Co, Redwood City, Calif) were used to close both common femoral arteriotomies. Postoperatively, the patient was observed in the intensive care unit overnight and was discharged home the next day with a CVP of 7 mm Hg and a creatinine of 1.3 mg/dL. Follow-up imaging will include a CT scan at one month, six months, and then annually. 1 Eskandari M.K. Yao J.S.T. Pearce W.H. Rutherford R.B. Veith F.J. Harris P. et al. Surveillance after endoluminal repair of abdominal aortic aneurysms. Cardiovasc Surg. 2001; 9: 469-471 Crossref PubMed Scopus (22) Google Scholar

Posterior “nutcracker” phenomenon: hemodynamic relevant aorto‐retroaortal renal vein fistula leading to fatal right heart failure

A rare complication of an aneurysm of the abdominal aorta is the so-called "posterior nutcracker phenomenon", which describes compression of a retroaortal renal vein between the abdominal aorta and the vertebral column. The clinical presentation is flank pain and hematuria, which are usually caused by a renal (respectively ureteral) calculus or neoplasia. Another rare differential diagnosis for these very common clinical symptoms is an aorto-left renal vein fistula (ALRVF), which is a spontaneous vascular fistula, usually also associated with an aortic aneurysm, infrequently a result of abdominal trauma.

Iliac Arteriovenous Fistula With Renal Insufficiency, Ascites, Hepatomegaly, and Abnormal Liver Test Results

Iliac Arteriovenous Fistula With Renal Insufficiency, Ascites, Hepatomegaly, and Abnormal Liver Test Results

Aorto—Left Renal Vein Fistula: Is There a Place for Endovascular Management?

Purpose: To describe the endovascular treatment of an aorto-left renal vein fistula. Methods and Results: A 77-year-old man with multiple comorbidities presented with low back pain, hematuria, cyanosis, and a pulsatile abdominal mass. Imaging confirmed a 7-cm abdominal aortic aneurysm with a contained rupture into the left renal vein. Owing to the patient's high surgical risk, a Talent Endoluminal Stent-Graft was implanted to satisfactorily exclude the aneurysm. Hemodynamic stability and normal renal function were restored; however, continued perfusion of the sac prompted an attempt to percutaneously repair the renal vein defect. This effort failed, so open laparotomy was necessary. Conclusions: Although total endovascular management was not successful in this case, the initial use of a minimally invasive approach allowed the patient's clinical status to improve and lower the risk of subsequent surgery.

Aortic Aneurysm Rupture Into a Retroaortic Left Renal Vein

We report the case of a patient who was transferred to our facility after a CT scan obtained at a local hospital revealed a leaking abdominal aortic aneurysm. Review of the scan showed an aorto-left renal vein fistula. Knowing this fistula was present made the operative repair of the aneurysm and control of the fistula much more straightforward than might otherwise have been the case. Although relatively rare, major anomalies of the renal veins and perirenal vena cava should be borne in mind when operating on the abdominal aorta. This case illustrates the merit of contrast-enhanced CT scanning prior to aortic surgery.

Traumatic fistula between the aorta and the left renal vein: Case report and review of the literature

This report of an aorto—left renal vein fistula (ALRVF) of traumatic origin is the sixth such case on record. The fistula was successfully repaired, with preservation of the kidney, by autotransfusion. Review of the English language literature revealed the differences between spontaneous and traumatic ALRVF. Spontaneous fistulas were caused by rupture of an abdominal aortic aneurysm into a retroaortic left renal vein. Hematuria was almost constant (93% of cases). The operative mortality rate was 14%. By contrast, traumatic ALRVFs were the result of a penetrating wound to the abdomen. The left renal vein was in a normal position, anterior to the aorta. Hematuria was less common (16% of cases). The diagnosis was delayed because clinical signs were less acute. There were no reports of postoperative deaths.