Right iliac arteriovenous fistula due to aneurysm rupture and left iliac artery aneurysm: hybrid treatment

An arteriovenous fistula (AVF) is an uncommon sequela of spontaneous arterial aneurysm rupture into the adjacent venous system. We describe the case of a 74-year-old patient who underwent endovascular treatment of a right iliac AVF caused by a ruptured common iliac artery (CIA) aneurysm and a distal left CIA aneurysm. Surgery preserved the lumbar and inferior mesenteric arteries because of the need to simultaneously exclude the hypogastric arteries. Dynamic fluid balance phenomena provoked by closure of the AVF are described. The patient had a benign postoperative course with normalization of the severe hemodynamic changes presented prior to the intervention and resolution of respiratory symptoms attributed to pulmonary arterial hypertension.

Keywords:
arteriovenous fistula; iliac aneurysm; iliac vein; iliac artery; heart failure; aneurysm; ruptured

Authorship

Adalberto Pereira de Araujo

conception and design

analysis and interpretation

data collection

writing the article

overall responsibility

Centro Angiocardiológico, Rio de Janeiro, RJ, Brasil.Centro AngiocardiológicoBrasilRio de Janeiro, RJ, BrasilCentro Angiocardiológico, Rio de Janeiro, RJ, Brasil.

Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de JaneiroBrasilRio de Janeiro, RJ, BrasilUniversidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brasil.

http://orcid.org/0000-0003-2221-5857

Cristiane Ferreira de Araujo Gomes

conception and design

analysis and interpretation

data collection

writing the article

Centro Angiocardiológico, Rio de Janeiro, RJ, Brasil.Centro AngiocardiológicoBrasilRio de Janeiro, RJ, BrasilCentro Angiocardiológico, Rio de Janeiro, RJ, Brasil.

Universidade do Estado do Rio de Janeiro - UERJ, Hospital Universitário Pedro Ernesto - HUPE, Rio de Janeiro, RJ, Brasil.Universidade do Estado do Rio de JaneiroBrasilRio de Janeiro, RJ, BrasilUniversidade do Estado do Rio de Janeiro - UERJ, Hospital Universitário Pedro Ernesto - HUPE, Rio de Janeiro, RJ, Brasil.

Douglas Poschinger-Figueiredo

analysis and interpretation

data collection

writing the article

Centro Angiocardiológico, Rio de Janeiro, RJ, Brasil.Centro AngiocardiológicoBrasilRio de Janeiro, RJ, BrasilCentro Angiocardiológico, Rio de Janeiro, RJ, Brasil.

http://orcid.org/0000-0002-4533-603X

Carlos Felipe da Silva Delgado

data collection

critical revision

Centro Angiocardiológico, Rio de Janeiro, RJ, Brasil.Centro AngiocardiológicoBrasilRio de Janeiro, RJ, BrasilCentro Angiocardiológico, Rio de Janeiro, RJ, Brasil.

Hospital Estadual Eduardo Rabello, Rio de Janeiro, RJ, Brasil.Hospital Estadual Eduardo RabelloBrasilRio de Janeiro, RJ, BrasilHospital Estadual Eduardo Rabello, Rio de Janeiro, RJ, Brasil.

Monica Rochedo Mayall

data collection

critical revision

Centro Angiocardiológico, Rio de Janeiro, RJ, Brasil.Centro AngiocardiológicoBrasilRio de Janeiro, RJ, BrasilCentro Angiocardiológico, Rio de Janeiro, RJ, Brasil.

Flavia Figueira Baltharejo Campanario

data collection

critical revision

Centro Angiocardiológico, Rio de Janeiro, RJ, Brasil.Centro AngiocardiológicoBrasilRio de Janeiro, RJ, BrasilCentro Angiocardiológico, Rio de Janeiro, RJ, Brasil.

Complexo Hospitalar de Niterói - CHN, Niterói, RJ, Brasil.Complexo Hospitalar de NiteróiBrasilNiterói, RJ, BrasilComplexo Hospitalar de Niterói - CHN, Niterói, RJ, Brasil.

Clinic Care - Grupo Geriatics, Niterói, RJ, Brasil.Clinic Care - Grupo GeriaticsBrasilNiterói, RJ, BrasilClinic Care - Grupo Geriatics, Niterói, RJ, Brasil.

Felipe Borges Fagundes

data collection

critical revision

Centro Angiocardiológico, Rio de Janeiro, RJ, Brasil.Centro AngiocardiológicoBrasilRio de Janeiro, RJ, BrasilCentro Angiocardiológico, Rio de Janeiro, RJ, Brasil.

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Ethics committee approval: The manuscript was approved by the Ethics Committee of the Universidade Estadual do Rio de Janeiro (UERJ). CAAE: 48467621.8.0000.5282; Number: 4.821944.

Correspondence Adalberto Pereira de Araujo Centro Angiocardiológico Estrada do Portela, 99, Grupo 917/918 CEP 21351-050 - Rio de Janeiro (RJ), Brasil Tel.: +55 (21) 3350-1908 / +55 (21) 98706-0606 E-mail: adalbertopa@gmail.com

Author information APA - Director, Centro Angiocardiológico; Volunteer collaborating professor, Universidade Federal do Rio de Janeiro (UFRJ); PhD in Medicina, UFRJ. CFAG - Chief of clinic, Centro Angiocardiológico; Assistant vascular surgeon, Unidade Docente Assistencial de Cirurgia Vascular e Endovascular, Hospital Universitário Pedro Ernesto (HUPE), Universidade do Estado do Rio de Janeiro (UERJ). DPF - Assistant vascular surgeon, Centro Angiocardiológico; Assistant vascular surgeon, Unidade Docente Assistencial de Cirurgia Vascular e Endovascular, Hospital Universitário Pedro Ernesto (HUPE), Universidade do Estado do Rio de Janeiro (UERJ); Mestre em Saúde, UERJ. CFSD - Assistant vascular surgeon, Centro Angiocardiológico; Vascular surgeon, Hospital Estadual Eduardo Rabello. MRM and FBF - Assistant vascular surgeons, Centro Angiocardiológico; Assistant vascular surgeons, Unidade Docente Assistencial de Cirurgia Vascular e Endovascular, Hospital Universitário Pedro Ernesto (HUPE), Universidade do Estado do Rio de Janeiro (UERJ). FFBC - Assistant vascular surgeon, Centro Angiocardiológico; Vascular surgeon, Complexo Hospitalar de Niterói (CHN), Clinic Care - Grupo Geriatics.

SCIMAGO INSTITUTIONS RANKINGS

Centro Angiocardiológico, Rio de Janeiro, RJ, Brasil.Centro AngiocardiológicoBrasilRio de Janeiro, RJ, BrasilCentro Angiocardiológico, Rio de Janeiro, RJ, Brasil.

Hospital Estadual Eduardo Rabello, Rio de Janeiro, RJ, Brasil.Hospital Estadual Eduardo RabelloBrasilRio de Janeiro, RJ, BrasilHospital Estadual Eduardo Rabello, Rio de Janeiro, RJ, Brasil.

Complexo Hospitalar de Niterói - CHN, Niterói, RJ, Brasil.Complexo Hospitalar de NiteróiBrasilNiterói, RJ, BrasilComplexo Hospitalar de Niterói - CHN, Niterói, RJ, Brasil.

Clinic Care - Grupo Geriatics, Niterói, RJ, Brasil.Clinic Care - Grupo GeriaticsBrasilNiterói, RJ, BrasilClinic Care - Grupo Geriatics, Niterói, RJ, Brasil.

Figures

Figures (3)

Thumbnail

Figure 1
Angiotomography showing (A) and (B) an aneurysm with a diameter of 60 mm along the entire length of the right common iliac artery. Note the significant dilation of the inferior vena cava (37 mm); (C) note the fistula orifice (arrow); (D) aneurysm with a diameter of 30 mm at the bifurcation of the left common iliac artery. AO = aorta; CIA = common iliac artery; IVC = inferior vena cava; LCIA = left common iliac artery; RCIA = right common iliac artery.

Thumbnail

Figure 2
Pelvic radiography and transoperative control angiography. (A) Fibered coils occluding the hypogastric arteries; (B) aorto-uni-iliac stent graft positioned and ready for release, immediately above the bifurcation of the aorta. Observe the marking at the start of the covered portion (arrow); (C) endoprosthesis deployed and encompassing the terminal segment of the aorta below the inferior mesenteric artery, well aligned, and free from leaks. Observe the arrow at the start of the knitted portion; (D) distal extremity of the endoprosthesis at the mid segment of the external iliac artery, with normal patency.

Thumbnail

Figure 3
Angiotomography at 6 postoperative months. (A) Aorto-uni-iliac stent graft up to the mid segment of the right external iliac artery, well-aligned. Femoro-femoral cross-over bypass with normal patency and free from kinking or stenosis. Occluding stent in the left external iliac artery; (B) sagittal view confirming patency of the endoprosthesis and the aneurysm with no leakage.

Figure 1 Angiotomography showing (A) and (B) an aneurysm with a diameter of 60 mm along the entire length of the right common iliac artery. Note the significant dilation of the inferior vena cava (37 mm); (C) note the fistula orifice (arrow); (D) aneurysm with a diameter of 30 mm at the bifurcation of the left common iliac artery. AO = aorta; CIA = common iliac artery; IVC = inferior vena cava; LCIA = left common iliac artery; RCIA = right common iliac artery.

Figure 2 Pelvic radiography and transoperative control angiography. (A) Fibered coils occluding the hypogastric arteries; (B) aorto-uni-iliac stent graft positioned and ready for release, immediately above the bifurcation of the aorta. Observe the marking at the start of the covered portion (arrow); (C) endoprosthesis deployed and encompassing the terminal segment of the aorta below the inferior mesenteric artery, well aligned, and free from leaks. Observe the arrow at the start of the knitted portion; (D) distal extremity of the endoprosthesis at the mid segment of the external iliac artery, with normal patency.

Figure 3 Angiotomography at 6 postoperative months. (A) Aorto-uni-iliac stent graft up to the mid segment of the right external iliac artery, well-aligned. Femoro-femoral cross-over bypass with normal patency and free from kinking or stenosis. Occluding stent in the left external iliac artery; (B) sagittal view confirming patency of the endoprosthesis and the aneurysm with no leakage.

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Right iliac arteriovenous fistula due to aneurysm rupture and left iliac artery aneurysm: hybrid treatment

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[1] Conflicts of interest: No conflicts of interest declared concerning the publication of this article.