title: Aortocaval Fistula: Is Endovascular Repair the Preferred Solution?
abstract: BACKGROUND
  To compare outcomes of open and endovascular repair of aortocaval fistulas (ACFs) in the setting of abdominal aortic aneurysms (AAAs).
  
  
  METHODS
  A literature review was undertaken on Pubmed from 1999 to 2014 to identify reported cases of both endovascular and open repair of ACF, including the index case, presented here. Primary outcomes for endovascular repair were: complications, presence of endoleak, and death. Primary outcomes for open repair were: complications and death.
  
  
  RESULTS
  Forty articles were reviewed with a total of 67 patients, including the index case. Endovascular approach was used in 26 patients (39%). Endoleaks were present in 50%, whereas similarly 46% of patients had a reported complication. Five deaths (19%) occurred in the endovascular group. Open repair was performed in 41 cases (61%). The rate of complication and the death in open repair were 36% and 12%, respectively (P = 0.327 and P = 0.910, respectively) compared with endovascular. Mean follow-up was 7.7 months for the endovascular group and 8.5 months in the open group.
  
  
  CONCLUSIONS
  Previous demonstrations of high morbidity and mortality with open repair of ACF in the setting of AAA have motivated endovascular approaches. However, endoleaks are a significant problem and were present in 50% of ACF cases. The continued presence of an endoleak in the setting of an ACF may result in persistence of the ACF, unlikely thrombosis of the endoleak, and continued sac enlargement. Endovascular repair presents theoretical benefit, yet is not associated with a reduced rate of complication or death versus open repair in this contemporary review.
authors.affiliation: Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Kristine Clodfelter
authors.initials: KC
authors.lastname: Orion
authors.affiliation: Department of General Surgery, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Beaulieu
authors.affiliation: Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, Baltimore, MD. Electronic address: jhblack@jhmi.edu.
authors.forename: James H
authors.initials: JH
authors.lastname: Black
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D017548:Echocardiography, Transesophageal; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D020127:Recovery of Function; D012307:Risk Factors; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000503:physiopathology / Q000601:surgery*