Endovascular repair for arterio-venous fistula treatment: a case report

Arterio-venous fistula is a rare clinical entity that occurs as a result of a ruptured abdominal aortic aneurysm into the inferior vena cava or iliac vein. Open surgery has been considered the treatment of choice for this condition; however, endovascular repair has become an evolving therapeutic option over the past 20 years. The endovascular treatment has contributed to a decrease in the perioperative mortality; nevertheless, some endovascular repair specific concern for residual fistula still remains.

A 70-year-old man was referred to our department for an enlarged inferior vena cava without any complaint. Contrast-enhanced computed tomography demonstrated a 40-mm AAA and a 42-mm right saccular CIAA, with a fistula between the CIAA and left CIV. Endovascular aneurysm repair which focused on the exclusion of the right CIAA and prevention of endoleak formation was performed. To prevent type 2 endoleaks, which cause residual arterio-venous shunt flow, right internal iliac artery was embolized with a vascular plug prior to stent graft procedure. Successful aneurysm exclusion without residual arterio-venous shunt flow was confirmed with a final angiographic examination. The patient had an uneventful recovery, and computed tomography 1 month later showed no sign of persistent fistula.

Although endovascular treatment for AVF has a negative possibility of residual shunt, stent graft with a focus on type 2 endoleak prevention can be an attractive treatment option, reducing the incidence of residual AVF.