First Department of General and Vascular Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
J Endovasc Ther. 2011 Apr;18(2):250-4. doi: 10.1583/10-3296.1.
To report a case in which a persistent high-flow type II endoleak after endovascular aneurysm repair (EVAR) of a leaking abdominal aortic aneurysm (AAA) complicated by an aortocaval fistula was repaired with a stent-graft in the inferior vena cava (IVC).
A 76-year-old man underwent emergent EVAR with an aortomonoiliac device to exclude a leaking 9-cm AAA. The 30-day computed tomography (CT) scan showed 2-mm sac expansion and a type II endoleak arising from a lumbar artery; the outflow vessel was the inferior vena cava (IVC) via a fistula that was not depicted on the non-contrast preoperative CT or the intraoperative angiogram. No intervention was deemed necessary at the time. Six months after EVAR, the AAA had not expanded further, but the fistula between the sac and the IVC was larger in diameter. A tubular stent-graft was implanted in the IVC to seal the defect. No complications have been noted up to 36 months after the IVC stent-graft procedure.
Aortocaval fistulae should be excluded in the case of persistent type II endoleaks after EVAR for ruptured AAAs. IVC endografting is a minimally invasive alternative to treat such a complication, with promising midterm results in this patient.
报告 1 例腹主动脉瘤破裂行血管内修复术（EVAR）后并发主动脉-腔静脉瘘的持续性高流量 II 型内漏患者，采用下腔静脉（IVC）支架移植物进行修复。
1 例 76 岁男性，因破裂性 9cm 腹主动脉瘤行急诊 EVAR，采用腹主动脉-单髂动脉装置。30 天 CT 扫描显示 2mm 囊腔扩张和 II 型内漏起源于腰动脉；流出血管是通过瘘管进入下腔静脉（IVC），而术前非增强 CT 或术中血管造影均未显示该瘘管。当时认为无需进行干预。EVAR 后 6 个月，AAA 未进一步扩张，但囊腔与 IVC 之间的瘘管直径增大。在 IVC 中植入管状支架移植物以封闭缺损。IVC 支架移植术后 36 个月，未见任何并发症。
对于破裂性 AAA 行 EVAR 后持续性 II 型内漏，应排除主动脉-腔静脉瘘。IVC 腔内移植物置入术是治疗此类并发症的一种微创替代方法，在该患者中具有良好的中期结果。
