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Emergency endovascular repair of aortocaval fistula--a single center experience
Solomon Akwei1, Nishath Altaf, William Tennant
1Queens Medical Centre, Nottingham, UK. sakwei@doctors.org.uk
Insights
Emergency endovascular repair of aortocaval fistula (ACF) secondary to abdominal aortic aneurysm (AAA) is challenging. Early diagnosis and management are crucial for improving patient outcomes in this rare condition.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortic Aneurysm Management
Background:
- Aortocaval fistula (ACF) secondary to abdominal aortic aneurysm (AAA) is a rare but serious complication.
- Prompt diagnosis and intervention are critical for patient survival.
Observation:
- This case series reviewed 4 patients undergoing emergency endovascular repair of ACF associated with AAA.
- Three patients were initially misdiagnosed, highlighting diagnostic challenges.
- High early postoperative mortality (3/4) and complications (persistent endoleak in 1/4) were observed.
Findings:
- Emergency endovascular repair of ACF secondary to AAA demonstrated significant challenges and high mortality in this small series.
- Delayed diagnosis negatively impacted patient outcomes.
Implications:
- Emphasizes the critical need for heightened clinical suspicion and early diagnosis of ACF in patients with AAA.
- Suggests that while challenging, endovascular repair may offer a potential treatment avenue, necessitating further research and experienced management.
- Highlights the importance of specialized centers for managing complex vascular emergencies.
Purpose:
To review the outcomes of patients undergoing emergency endovascular repair of aortocaval fistula (ACF) secondary to abdominal aortic aneurysm (AAA).
Case Report:
Four consecutive patients who underwent emergency endovascular repair of ACF associated with AAA in a tertiary institution between 2002 and 2009. Of the 4 patients, 3 had initially been misdiagnosed and managed for several days by other specialists for their symptoms prior to diagnosis of their ACF. Three patients died in the early postoperative period. The fourth patient made a satisfactory postoperative recovery but subsequently required further endovascular surgery to treat a persistent type 1 endoleak.
Conclusions:
Our experience illustrates the importance of early diagnosis and management of ACF. Even in experienced hands, the management of spontaneous ACF associated with AAA is challenging. Endovascular surgery may still have a role in improving outcomes in these patients.