[Multimodal approach in coincidence of covered ruptured abdominal aortic aneurysm and aortocaval fistula].
METHODS
A 71-year-old patient had been referred to our hospital with the diagnosis, made by angio-computed tomography (CTA), of a covered ruptured abdominal aortic aneurysm (AAA) resulting in an aortocaval fistula (ACF).


METHODS
The physical examination revealed macrohematuria and high-output heart failure with increasing circulatory insufficiency.


METHODS
An open endovascular procedure was not possible because the AAA had extended into both internal iliac arteries. A bifurcated prosthesis connecting to both femoral arteries was then successfully implanted and the infrahepatic aortocaval fistula closed by a patch through the AAA. Ischemic colitis, diagnosed on postoperative day 2 (POD 2), was successfully treated with antibiotics. CTA, done on POD 5, revealed a small residual ACF, filling retrogradely from the right external iliac artery via the surgically closed aneurysmal sack. Closure of the residual ACF was achieved with an Amplatz occluder inserted into the right external iliac artery, introduced percutaneously via the right femoral artery. The postoperative course was uneventful and the patient discharged on POD 13.


CONCLUSIONS
The coincidence of AAA and ACF is rare. However, the morbidity and mortality are high and require early diagnosis and immediate treatment.
Klinik für Allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie.
M
M
von Heesen
J
J
Sperling
T
T
Plusczyk
A
A
Bücker
M
M
Katoh
M K
MK
Schilling
M R
MR
Moussavian
D000368:Aged; D000792:Angiography / Q000379:methods; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001018:Aortic Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D001019:Aortic Rupture / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001027:Aortography / Q000379:methods; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D001807:Blood Vessel Prosthesis; D017091:Colitis, Ischemic / Q000188:drug therapy / Q000209:etiology; D003131:Combined Modality Therapy; D006801:Humans; D007083:Iliac Artery / Q000473:pathology; D008297:Male; D011379:Prognosis; D055989:Septal Occluder Device; D014057:Tomography, X-Ray Computed / Q000379:methods; D014682:Vena Cava, Inferior / Q000002:abnormalities* / Q000000981:diagnostic imaging