Aorto-caval fistula from acute rupture of an abdominal aortic aneurysm treated with a hybrid approach Matthias Siepe, MD, Sabrina Koeppe, MD, Wulf Euringer,

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Aorto-caval fistula from acute rupture of an abdominal aortic aneurysm treated with a hybrid approach Matthias Siepe, MD, Sabrina Koeppe, MD, Wulf Euringer, MD, Christian Schlensak, MD Journal of Vascular Surgery Volume 49, Issue 6, Pages 1574-1576 (June 2009) DOI: 10.1016/j.jvs.2008.12.074 Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 1 A and B, Preoperative CT-scan in a 64-slice scanner with an iodine contrast agent. The abdominal infrarenal aorta was extremely dilated to a diameter of 13 cm and had ruptured into the inferior vena cava just cephalad the confluence of the iliac veins. The rupture site was judged to be over 3 cm long. The upper part of the aneurysm was heavily kinked and degenerated, and the iliac arteries were severely calcified. This made endovascular treatment of the aorta inappropriate. Journal of Vascular Surgery 2009 49, 1574-1576DOI: (10.1016/j.jvs.2008.12.074) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 2 Intraoperative view of the aortic aneurysm sack with the first Dacron prosthesis which had been anastomosed to the proximal infrarenal aorta (§). The wall of the aortic aneurysm (*) was ruptured, and the caval stent graft was visible through a 3 × 4 cm defect (#). Using two polypropylene sutures, the stent material was fixed and partly covered by the aneurysm wall with no bleeding from the vein. Journal of Vascular Surgery 2009 49, 1574-1576DOI: (10.1016/j.jvs.2008.12.074) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 3 A and B, Postoperative CT-scan in a 64-slice scanner with an iodine contrast agent. The aortic Dacron graft inside the old aneurysm sack is perfused normally with some hematoma inside the sack. The inferior vena cava is successfully splinted by endovascular stent grafts. The examination revealed no indication that the fistula was leaking, nor any residual perfusion in the aneurysm sack. Journal of Vascular Surgery 2009 49, 1574-1576DOI: (10.1016/j.jvs.2008.12.074) Copyright © 2009 Society for Vascular Surgery Terms and Conditions