Staged endovascular repair of an abdominal aortic aneurysm adjacent to a chronic high- flow iliocaval traumatic arteriovenous fistula S. Keisin Wang,

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Presentation transcript:

Staged endovascular repair of an abdominal aortic aneurysm adjacent to a chronic high- flow iliocaval traumatic arteriovenous fistula S. Keisin Wang, MD, Ashley R. Gutwein, MD, Tom Casciani, MD, Michael P. Murphy, MD, Gary W. Lemmon, MD Journal of Vascular Surgery Cases and Innovative Techniques Volume 3, Issue 4, Pages 247-250 (December 2017) DOI: 10.1016/j.jvscit.2017.10.004 Copyright © 2017 The Author(s) Terms and Conditions

Fig 1 A, Preoperative computed tomography angiography (CTA) demonstrated a large 8.5-cm infrarenal abdominal aortic aneurysm (AAA) concerning for impending rupture and signs of a left-sided iliocaval traumatic arteriovenous fistula (tAVF). B, There was significant collateralization in the retroperitoneum, making an open operation prohibitively risky. C, Fistulous connection is observed between the left common iliac artery (CIA) and the proximal right common iliac vein (CIV) or distal vena cava (arrow). Journal of Vascular Surgery Cases and Innovative Techniques 2017 3, 247-250DOI: (10.1016/j.jvscit.2017.10.004) Copyright © 2017 The Author(s) Terms and Conditions

Fig 2 A-C, During the index procedure, injection of the right common iliac artery (CIA; arrow) demonstrated flow through pelvic collaterals to the left CIA. An anomalous connection was discovered from the left CIA to the inferior vena cava (arrow). D, An aortouni-iliac Gore Excluder was deployed to temporize the abdominal aortic aneurysm (AAA), with an excellent angiographic result. E, Three-dimensional reconstruction of the postoperative result. Journal of Vascular Surgery Cases and Innovative Techniques 2017 3, 247-250DOI: (10.1016/j.jvscit.2017.10.004) Copyright © 2017 The Author(s) Terms and Conditions

Fig 3 A, Through the superior mesenteric artery, an inferior mesenteric artery (IMA; arrow) angiogram was obtained to visualize the large type II endoleak. B, Several microcoils (arrow) were deployed between the IMA origin and the left colic takeoff to thrombose the endoleak source. C, Through the left common femoral vein, the fistulous track (arrow) was identified. D, An Amplatzer II vascular plug was deployed to close the traumatic arteriovenous fistula (tAVF; arrow). Journal of Vascular Surgery Cases and Innovative Techniques 2017 3, 247-250DOI: (10.1016/j.jvscit.2017.10.004) Copyright © 2017 The Author(s) Terms and Conditions

Fig 4 A, Computed tomography angiography (CTA) at 18-month follow-up demonstrated stable position of the endograft and microcoils (arrow). B, The previously identified type II endoleak was not observed. C, The Amplatzer device (arrow) was in good position, with no further evidence of traumatic arteriovenous fistula (tAVF). Journal of Vascular Surgery Cases and Innovative Techniques 2017 3, 247-250DOI: (10.1016/j.jvscit.2017.10.004) Copyright © 2017 The Author(s) Terms and Conditions