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Endovascular aortic stenting in patients with chronic traumatic aortocaval fistula
Tanop Srisuwan1, Rungsrit Kanjanavanit2, Kittipan Rerkasem3
1Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Insights
This study details the endovascular repair of a chronic traumatic aortocaval fistula (ACF), a rare condition causing heart failure. While effective, the procedure requires anticipating potential hemodynamic complications like bradycardia and diuresis.
Area of Science:
- Vascular Surgery
- Cardiology
- Trauma Management
Background:
- Chronic traumatic aortocaval fistula (ACF) is a rare but serious condition, often presenting late with significant hemodynamic compromise.
- Delayed presentation of ACF can lead to progressive heart failure and other cardiovascular complications.
Observation:
- A 59-year-old male presented with heart failure secondary to a 41-year-old traumatic ACF.
- The patient underwent endovascular aortic stenting for ACF closure.
Findings:
- Endovascular aortic stenting is an effective alternative to open surgery for chronic ACF repair.
- Post-procedure complications included severe bradycardia (Nicoladoni-Branham sign) and excessive diuresis, necessitating vigilant monitoring.
Implications:
- Endovascular repair offers a less invasive option for managing chronic ACF.
- Anticipation and management of specific hemodynamic complications are crucial for successful outcomes in chronic ACF cases.
Abstract:
This study aimed to present the treatment of a case of delay presenting of traumatic aortocaval fistula (ACF) and its effect on hemodynamic problem. A 59-year-old man was admitted to our hospital with heart failure due to a 41-year-old traumatic ACF. ACF closure was performed by endovascular aortic stenting. His hospital course after procedure was complicated by severe bradycardia and torsades de pointes and excessive diuresis. We concluded the endovascular technique provided an attractive alternative to open surgical methods for repair of chronic ACF. However, in chronic cases, complications such as severe bradycardia (Nicoladoni-Branham sign) and excessive diuresis must be anticipated.
