Endovascular repair of an aorto-left renal vein fistula due to a ruptured abdominal aortic aneurysm after EVAR.
OBJECTIVE
To report an unusual late complication of endovascular aneurysm repair: an arteriovenous fistula between the aneurysm sac and a retro-aortic left renal vein following sac expansion due to a type III endoleak.


METHODS
A 79-year-old man developed an arteriovenous fistula between the aneurysm sac and a retro-aortic left renal vein 67 months after endovascular aneurysm exclusion (EVAR). Aneurysm rupture was due to disconnection between the right iliac limb and an extender cuff. The problem was repaired percutaneously with another endograft bridging the two prostheses. At 16 months, the aneurysm sac diameter was decreased; there was no evidence of the AV fistula, and the patient was free from any complication related to the EVAR.


CONCLUSIONS
This case emphasizes the need of close surveillance even in the late postoperative course of these patients. Moreover, this rare event confirmed that endovascular techniques can play an important role in treating emergent complications.
Ferrari
Mauro
M
Unit of Vascular Surgery, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. m.ferrari@ao-pisa.toscana.it
Berchiolli
Raffaella
R
Sardella
Savino G
SG
Cioni
Roberto
R
Petruzzi
Pasquale
P
Del Corso
Andrea
A
Di Mitri
Roberto
R
Croce
Chiara
C
Romagnani
Francesco
F
Adami
Daniele
D
Mosca
Franco
F
D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001012:Aorta, Abdominal; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D011475:Prosthesis Failure; D011859:Radiography; D012082:Renal Veins; D012086:Reoperation; D018570:Risk Assessment; D016896:Treatment Outcome