Persisting iliaco-caval fistula after EVAR maintained by a type II endoleak

Area of Science:

• Vascular Surgery
• Endovascular Repair
• Aneurysm Management

Background:

• Endovascular aneurysm repair (EVAR) is a common treatment for abdominal and iliac aneurysms.
• Type II endoleaks are a potential complication following EVAR, often arising from patent internal iliac arteries or lumbar arteries.
• Iliaco-caval fistulas represent a rare but complex anatomical variation encountered during EVAR.

Observation:

• A case is presented of a patient experiencing a persistent type II endoleak after EVAR for an iliac aneurysm complicated by an iliaco-caval fistula.
• The specific pathophysiological mechanism contributing to the persistence of this endoleak in the context of the fistula is described.

Findings:

• Conservative management strategies are unlikely to achieve spontaneous sealing of type II endoleak in the presence of an iliaco-caval fistula.
• The fistula provides a continuous retrograde flow, challenging the natural hemostatic processes that might resolve simpler endoleaks.

Implications:

• A more aggressive treatment strategy is advocated for persistent type II endoleaks associated with iliaco-caval fistulas.
• This case highlights the need for tailored treatment plans for complex endovascular complications.
• Further research into optimal interventional techniques for such scenarios is warranted.