Aorta—left renal vein fistula syndrome caused by rupture of a juxtarenal abdominal aortic aneurysm: Novel pathologic mechanism for a unique clinical entity

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Presentation transcript:

Aorta—left renal vein fistula syndrome caused by rupture of a juxtarenal abdominal aortic aneurysm: Novel pathologic mechanism for a unique clinical entity Robert W. Thompson, MD *, Laurence F. Yee, MD, Eileen S. Natuzzi, MD, Ronald J. Stoney, MD Journal of Vascular Surgery Volume 18, Issue 2, Pages 310-315 (August 1993) DOI: 10.1016/0741-5214(93)90614-R Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Contrast-enhanced CT scan of abdomen demonstrates large, calcific, juxtarenal AAA, with contained rupture into left retroperitoneal/parapsoas space. No retroaortic venous anomaly was present. Journal of Vascular Surgery 1993 18, 310-315DOI: (10.1016/0741-5214(93)90614-R) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Transfemoral aortography of ruptured AAA with ALRVF. A, Contrast extravasation outside aortic wall (small arrows) into contained retroperitoneal space adjacent to left kidney (large arrows). B, Rapid contrast filling from contained rupture space into left renal vein (LRV, large arrow) and inferior vena cava (IVC), demonstrating presence of ALRVF (small arrows). Note complete emptying of contrast from rertroperitoneal space immediately after extravasation from ruptured AAA. Journal of Vascular Surgery 1993 18, 310-315DOI: (10.1016/0741-5214(93)90614-R) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Rupture of large juxtarenal AAA into left retroperitoneal space, creating avulsion of second left lumbar branch from its junction with otherwise normal left renal vein. Inset, left renal vein tear has allowed contained aneurysm rupture to decompress into venous system, creating high-flow arteriovenous fistula and ALRVF syndrome. Journal of Vascular Surgery 1993 18, 310-315DOI: (10.1016/0741-5214(93)90614-R) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions