title: Percutaneous treatment of a aorto-caval fistula in a old high risk patient.
abstract: BACKGROUND
  To remark the feasibility of endovascular treatment of an aorto-caval fistula in a old high risk patient with "hostile" abdomen for previous surgeries.
  
  
  METHODS
  In September 2009 a 81-years-old patient was admitted in emergency at our department because of abdominal pain and massive oedema of the lower extremities associated to dyspnoea (New York Heart Association (NYHA) functional class III). A CT scan showed an aorto-caval fistula involving the abdominal aorta below the renal arteries. This abnormal communication was likely due to the previous abdominal surgeries, was complicated by occlusion of the inferior vena cava at the diaphragm and was responsible for the massive oedema of the lower extremities. Because of unstable conditions and hostile abdomen the patient was considered unfit for conventional surgery and an endovascular approach was planned. After unsuccessful attempt by positioning of an Amplatzer vascular ring into the fistula, a Medtronic covered stent-grafts were implanted from the renal arteries to the both common iliac arteries. The patient had an impressive improvement characterized by a 18 Kg weight loss and a complete restoration of the functional capacity (from NYHA class III to NYHA class I) associated to a complete resolution of the lower extremities oedema as confirmed at the a month-CT-scan.
  
  
  CONCLUSIONS
  Endovascular surgery of aorto-caval fistula represents a good option in alternative to conventional surgery mostly in old high risk patient.
authors.affiliation: Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University of Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rapacciuolo
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: De Angelis
authors.forename: Elisa
authors.initials: E
authors.lastname: di Pietro
authors.forename: Roberto
authors.initials: R
authors.lastname: Puglia
authors.forename: Ettore
authors.initials: E
authors.lastname: Di Tommaso
authors.forename: Danilo
authors.initials: D
authors.lastname: Ruggiero
authors.forename: Bruno
authors.initials: B
authors.lastname: Amato
authors.forename: Gabriele
authors.initials: G
authors.lastname: Iannelli
mesh_terms: D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000002:abnormalities / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D001164:Arteriovenous Fistula / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D008297:Male; D012306:Risk; D014682:Vena Cava, Inferior / Q000002:abnormalities* / Q000601:surgery