title: Hybrid repair of an aortocaval fistula and inferior vena cava external compression caused by an inflammatory aortoiliac aneurysm: a case study.
abstract: BACKGROUND
  We report a case of aortocaval fistula successfully treated by hybrid operation.
  
  
  METHODS
  A 73-year-old female suffering from malignant lymphoma and painful leg edema was transferred to our institution. Computed tomography revealed an aortoiliac aneurysm. The inferior vena cava was compressed by displacement of the abdominal aortic aneurysm. The bilateral internal iliac and ovarian veins were markedly dilated. Diagnosis was an aortoiliac aneurysm with aortocaval fistula. The treatment options were open surgery or an intervention with bypass surgery. Because of narrow iliac access for a bifurcated stent graft, aorto-uni stentgraft treatment followed by bypass surgery was finally decided. Following stent graft insertion and iliofemoral artery bypass, the aneurysms and fistula were successfully excluded without endoleaks. To treat the inferior vena cava compression, the kissing technique was used to place bare metallic stents across the bilateral common iliac veins and inferior vena cava, which improved the clinical symptoms.
  
  
  RESULTS
  In this aortocaval fistula caused by AAA, a minimally invasive treatment of stentgraft and bypass surgery with venous flow recovery was chosen as a hybrid treatment. Intravascular intervention was the most suitable in this situation. Bare stent placement for venous occlusion was also effective for revascularization of vena cava flow.
  
  
  CONCLUSIONS
  Recent advances in endovascular devices, including stent grafts and bare metallic stents, will be helpful for effective noninvasive treatment for aortocaval fistula circulation.
authors.affiliation: Department of Radiology, Fujita Health University School of Medicine, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192 Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Banno
authors.affiliation: Department of Radiology, Fujita Health University School of Medicine, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192 Japan.
authors.forename: Hokuto
authors.initials: H
authors.lastname: Akamatsu
authors.affiliation: Department of Radiology, Fujita Health University School of Medicine, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192 Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Hanaoka
authors.affiliation: Department of Radiology, Fujita Health University School of Medicine, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192 Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Toyama
authors.affiliation: Department of Radiology, Fujita Health University School of Medicine, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192 Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Kato
keywords: Abdominal aortic aneurysm (AAA); Aortocaval fistula (ACF); Iliofemoral bypass; Inferior vena cava (IVC); Stent graft