Endovascular repair of a ruptured abdominal aortic and iliac artery aneurysm with an acute iliocaval fistula secondary to lymphoma.
Abdominal aortic aneurysms (AAA) are common and generally asymptomatic unless rupture occurs. A 3 to 4-cm AAA has a 1-2% risk of rupture over 5 years. We present the case of an 85-year-old male with a history of chronic lymphocytic leukemia, a 3-cm infrarenal AAA, and a 2-cm right common iliac artery aneurysm whose AAA ruptured and who developed an acute iliac artery-to-vena cava fistula secondary to eroding adenopathy from an aggressive low-grade lymphoma. Initially, an open repair was attempted but access to the aorta was not possible because of complete encasement of the infrarenal and suprarenal aorta with tumor that was clinically invading the aortic wall. Secondary tumor invasion into the aorta is a rare complication. An endovascular repair was accomplished with successful exclusion of both the aneurysm and the iliocaval fistula. Endovascular repair provides a valuable alternative in the "hostile abdomen" when standard open repair may be hazardous or impossible.
Williamson
Alan E
AE
Department of Surgery, Eisenhower Medical Center, Rancho Mirage, CA, USA. vascuguy@earthlink.net
Annunziata
Gary
G
Cone
Lawrence A
LA
Smith
Juliann
J
D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D017543:Iliac Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000473:pathology; D008297:Male; D015607:Stents; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*