title: Aneurysm Shrinkage Is Compatible With Massive Endoleak in the Presence of an Aortocaval Fistula: Potential Therapeutic Implications for Endoleaks and Spinal Cord Ischemia.
abstract: OBJECTIVE
  To present a patient with ruptured abdominal aortic aneurysm (AAA) and aortocaval fistula who was successfully treated with endovascular aneurysm repair in spite of developing a massive endoleak.
  
  
  METHODS
  A 70-year-old man with ruptured AAA and aortocaval fistula was treated with endovascular aneurysm repair (EVAR). During 8 years of follow-up, he had massive perfusion of the aneurysm sac by retrograde flow from the inferior mesenteric artery into the caval vein through the aortocaval fistula. The aneurysm diameter decreased continuously in spite of the type II endoleak. This observation illustrates the mechanisms of sac expansion and may have therapeutic implications for complicated type II endoleaks and prevention of spinal cord ischemia in thoracic stent-grafting.
  
  
  CONCLUSIONS
  EVAR can be applied in this rare setting because the ensuing high-flow endoleak is associated with sac shrinkage owing to depressurization by the caval shunt.
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden magnus.sveinsson@skane.se.
authors.forename: Magnus
authors.initials: M
authors.lastname: Sveinsson
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Sonesson
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Resch
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: Nuno V
authors.initials: NV
authors.lastname: Dias
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Holst
authors.affiliation: Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Malina
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001164:Arteriovenous Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D000072226:Computed Tomography Angiography; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology*; D057510:Endovascular Procedures / Q000009:adverse effects*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D010690:Phlebography / Q000379:methods; D012039:Regional Blood Flow; D020760:Spinal Cord Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D013152:Splanchnic Circulation; D013997:Time Factors; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: abdominal aortic aneurysm; aortocaval fistula; endoleak; endovascular aneurysm repair; ruptured aortic aneurysm; spinal cord ischemia