title: Emergency endograft placement for recurrent aortocaval fistula after conventional AAA repair.
abstract: OBJECTIVE
  To report a novel case in which a stent-graft was used to emergently treat an aortocaval fistula that recurred after conventional abdominal aortic aneurysm (AAA) repair.
  
  
  METHODS
  A 67-year-old man was treated urgently for ruptured AAA with surgical placement of a 16-mm Dacron interposition graft. During the procedure, an aortocaval fistula was repaired primarily. The patient was discharged in satisfactory condition but returned 20 days later with dyspnea, bilateral perimalleolar edema, and a bruit in the mesogastric region. The high flow fistula was again present just above the aortic bifurcation at the distal anastomosis of the existing graft. The patient's condition deteriorated rapidly, so a bifurcated Vanguard stent-graft was deployed in an emergency procedure. Subsequent imaging confirmed satisfactory closure of the fistula. The patient was discharged 8 days after endograft placement, and he continues to be without signs of fistula recurrence at 2 years.
  
  
  CONCLUSIONS
  Endograft treatment of vascular lesions in the acute setting is becoming more common as our experience with the devices grows. Endovascular repair of primary aortocaval fistulas appears to be an efficacious and minimally invasive means of dealing with these lesions in AAA patients.
authors: Department of Radiology, Tor Vergata University, Rome, Italy. enricopampana@hotmail.com
authors: Roberto
authors: R
authors: Gandini
authors: Arnaldo
authors: A
authors: Ippoliti
authors: Enrico
authors: E
authors: Pampana
authors: Andrea
authors: A
authors: Ascoli Marchetti
authors: Giuseppe
authors: G
authors: Raimondo Pistolese
authors: Giovanni
authors: G
authors: Simonetti
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001018:Aortic Diseases / Q000628:therapy*; D001019:Aortic Rupture / Q000601:surgery; D001164:Arteriovenous Fistula / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D004630:Emergencies; D006801:Humans; D008297:Male; D012008:Recurrence; D015607:Stents; D014682:Vena Cava, Inferior