title: Total endovascular management of ruptured aortocaval fistula: technical challenges and case report.
abstract: OBJECTIVE
  Primary aortocaval fistula (ACF) is a rare complication of ruptured abdominal aortic aneurysms (rAAA). Endovascular repair for rAAA (REVAR) provides an efficient, elegant and safe option, minimizing the risk of massive bleeding with open repair.
  
  
  METHODS
  Case 1: An 84-year-old man presented with a rAAA and ACF. He exhibited manifestations of congestive heart failure, pulmonary and renal impairment. An endovascular aortic aneurysm repair was undertaken and a bifurcated stent graft was deployed to treat the aneurysm and a second stent graft was deployed within the inferior vena cava to simultaneously seal the rAAA and the ACF. Case 2: A 73-year-old male patient presented with a rAAA and ACF. He exhibited manifestations of congestive heart failure and renal impairment with haematuria. REVAR was the plan for management. A bifurcated stent graft was used to treat the aneurysm and another bifurcated stent graft was placed within the inferior vena cava to seal the rAAA and the ACF.
  
  
  CONCLUSIONS
  Here in, we report the first two cases in the English literature of rAAA with ACF successfully managed with simultaneous endovascular stent-grafting of both the aorta and the inferior vena cava.
authors.affiliation: Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Galway, Ireland Vascular Surgery Unit, Department of Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Mohammed
authors.initials: M
authors.lastname: ElKassaby
authors.affiliation: Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Galway, Ireland.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Alawy
authors.affiliation: Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Galway, Ireland.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zaki
authors.affiliation: Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Galway, Ireland.
authors.forename: Niamh
authors.initials: N
authors.lastname: Hynes
authors.affiliation: Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Galway, Ireland.
authors.forename: Wael
authors.initials: W
authors.lastname: Tawfick
authors.affiliation: Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Galway, Ireland Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Galway, Ireland sherif.sultan@hse.ie.
authors.forename: Sherif
authors.initials: S
authors.lastname: Sultan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D057510:Endovascular Procedures / Q000295:instrumentation; D006801:Humans; D008297:Male; D010690:Phlebography / Q000379:methods; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Aortocaval fistula; EVAR; abdominal aortic aneurysm; rupture