Mr imaging t2weighted with fat suppression in a and ct fistulography b. Aortographic demonstration of an aortocaval fistula. Ligation of highflow aortocaval fistula improved right ventricular function. Aortocaval fistula treated by aortic exclusion sciencedirect. Reconstruction imaging showing fistula between iliac artery and vein. Mar 20, 2017 arteriovenous fistula avf maturation failure remains a major cause of morbidity and mortality in hemodialysis patients. We present a case of an aortocaval fistula diagnosed by using carbon dioxide gas without the use of traditional contrast media. A, chest ct scans before admission revealed bilateral diffuse. Preoperative computed tomographic diagnosis of an aortocaval fistula associated with aneurysm of the abdominal aorta. The acfs were not detected on preoperative computerized tomography ct. Contrastenhanced ultrasound ceus is an imaging technique with various indications, most of which refer to scheduled examinations.
Ruptured abdominal aortic aneurysm with aortocaval fistula. A contrastenhanced spiral computed tomography ct scan revealed mild dilation of the infrarenal aorta with calcification consistent with a small aortic aneurysm. Endovascular therapy of spontaneous aortocaval fistulae. Venous drainage patterns are a major determinant of clinical outcome in intracranial dural arteriovenous fistula davf patients. Primary aortocaval fistula acf is a rare complication of abdominal aortic aneurysm aaa, occurring in only 4% of ruptured cases and less than 1% of all aaas. Reports of aortocaval fistula as the source of pulmonary embolism are rare. Two aortocaval fistulas occurred af ter low caliber gunshot wotmds, and four iliac fistulas followed iatrogenic trauma during disk surgery. The first such case of aortocaval fistula was reported in 1831 in a 22yrold man in whom the etiology was probably syphilitic 4. Statistical analysis of the fistula detectability scores from the cta, mra, and dsa images was performed by using spss software, version 11.
Although hemodynamic changes following avf creation may impact avf remodeling and contribute to neointimal hyperplasia development. Nov, 2017 increased ephb4 and ephrinb2 expression during adaptive venous remodeling. Computed tomography imaging of the abdominal aortocaval fistula left 3d reconstruction of the heart, inferior vena cava, and abdominal aorta. Endovascular repair of a recurrent aortocaval fistula and. Delayed presentation of traumatic aortocaval fistula. Aortocaval fistula acf after rupture of an abdominal aortic dissecting. Although the most common cause is penetrating trauma, in the setting of abdominal aortic aneurysms aaas, the incidence is aortocaval fistula acf is a very rare and devastating complication of ruptured abdominal aortic aneurysms aaa. In six patients the av fistula resulted from pen etrating trauma. Diagnosis of aortocaval fistula by computed tomography. A diagnosis of aaa generally requires imaging confirmation that an. Impact of av on animals with mild renal dysfunction is not fully understood. Caudocranial scanning to evaluate an aortocaval fistula.
Signssymptoms of aaa abdominalflankback pain, shock if ruptured highoutput heart failure. Highoutput heart failure resulting from chronic aortocaval fistula. Angiography image shows filling of inferior vena cava during arterial phase, which confirms diagnosis of aortocaval fistula. Aortocaval fistula acf is a very rare and devastating complication of ruptured abdominal aortic aneurysms aaa. Living donor kidney transplantation is regarded as beneficial to allograft recipients and not particularly detrimental to the donors. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Many of these patients present with oliguric renal failure, a contraindication for the use of iodinated contrast in radiological studies. However, open surgical repair of this complication is associated with a high operative mortality and a significant complication rate. Rare causes include mycotic aneurysm, lues, and disorders of connective tissue, such as the ehlersdanlos and marfan syndromes. Background aortocaval fistula av in rat is a unique model of volumeoverload congestive heart failure and cardiac hypertrophy. The clinical symptoms are complex and varied, so diagnosis is typically confirmed by use of contrastenhanced multidetector computed tomography. Transcaval access and closure for transcatheter aortic. To report a novel case in which a stentgraft was used to emergently treat an aortocaval fistula that recurred after conventional abdominal aortic aneurysm aaa repair.
Aortocaval fistula is a rare entity, complicating about 0. Paradoxical pulmonary embolism secondary to aortocaval. Systemic vascular blood flow is reduced in rats with aortocaval fistula. Although the most common cause is penetrating trauma, in the setting of abdominal aortic aneurysms aaas, the incidence is aortocaval fistula. In these patients, prompt closure of the persistent fistula has been advocated. In the presence of a large abdominal aortic aneurysm, the computed tomography ct triad findings of. Surgical repair of a cm infrarenal abdominal aortic. During surgery, after opening the aneurysm and resection of the mural thrombus, a 2cm aortocaval fistula was found on the posteromedial. Aortocaval fistulas most typically form between the posterolateral aorta and adjacent ivc and may present with symptoms of a pulsatile abdominal mass, abdominal and back pain, and high. We report a case of paradoxical pulmonary embolism secondary to an aortocaval fistula. Dec 05, 2018 ct scanning of the abdomen and pelvis is the most sensitive imaging test for detecting a colovesical fistula, and ct scanning should be included as part of the initial evaluation of suspected colovesical fistulae.
Caused by inflammation around aorta adherence of aorta to vein pressure and erosion into vein fistula. Aortocaval fistula acf and false aneurysm are a recognized complication of open abdominal aortic aneurysm aaa repair. Spontaneous aortocaval fistula is an unusual but well recognized complication of abdominal aortic aneurysm. Endovascular therapy of spontaneous aortocaval fistulae associated with abdominal aortic aneurysms luis r. Further educational programs should be developed, which may give rise to earlier. Aortocaval fistula acf in patients operated for ruptured acute. The rational approach to diagnostic imaging for ureterolithiasis. Acute coronary syndrome secondary to aortocaval fistula. In human avf and a mouse aortocaval fistula model, ephb4 protein expression increased in the fistula vein. To our knowledge, this is the first report of aortic exclusion being used as the surgical treatment of an aortocaval fistula. Despite continuous progress in our understanding of the pathogenesis of congestive heart failure chf and its management, mortality remains high. Pa tients with a traumatic fistula were much younger. None was associated with arteriosclerotic aneurysm, and in only 1 instance was there even mention of arteriographic study. Aortocaval fistula is a similarly rare phenomenon occurring in only 1% of abdominal aortic aneurysms and 4% of ruptured aneurysms at the time of operation.
Aortocaval fistula acf is an uncommon complication of abdominal aortic aneurysms aaa that requires urgent action. Most often, ccfs are broadly classified as either direct or indirect, on the basis of anatomic features depicted on angiograms. Aortic and inferior vena cava bifurcated stent graft. Murine model of central venous stenosis using aortocaval fistula with an outflow stenosis toshihiko isaji 1,2,3, shun ono 1,2,4,5, takuya hashimoto 1,2,3, kota yamamoto 1,2,3, ryosuke taniguchi 1,2,3, haidi hu 1,2, tun wang 1,2, jun koizumi 4, toshiya nishibe 5, katsuyuki hoshina 3, alan dardik 1,2,6. Aortographic demonstration of an aortocaval fistula radiology. Various sequence selections have been proposed for fistula imaging. Matrix metalloproteinase inhibition limits arterial enlargements in a rodent arteriovenous.
In this study, we sought to identify mr imaging finding differences between davf types classified on the basis of venous drainage patterns. Axial ct angiograms show aortocaval fistula arrow and right retroperitonealhemorrhage. Aortocaval fistula acf identified as direct communication between the distal ivc and patent lumen of large, extensively thrombosed infrarenal aortic aneurysm arrowheads, depicted on axial b, oblique coronal c, and threedimensional volumerendered d images. Lehman 1 in 1938 reported a case of aortocaval fistula with an underlying syphilitic abdominal aortic aneurysm.
Presentation depends on origin, size, and location of fistula. Spontaneous aortocaval fistula due to abdominal aortic aneurysm. Syneture, norwalk, ct, usa, and the skin was closed with horizontal mattress. However, avf and aaa usually cause no symptoms except when they rupture. May 28, 2014 aortocaval fistula is a rare entity, complicating about 0.
A challenge for endovascular management show all authors. Emergency endograft placement for recurrent aortocaval. Department of vascular surgery, bassini teaching hospital, university of milan, milan, italy see. A western blot and adjacent bar graph of densitometry showing human ephb4 expression in avf venous limb compared to. Aortocaval fistula article pdf available in the western journal of emergency medicine 1. Primary aortocaval fistua associated with abdominal aortic.
Nov 25, 2016 ligation of highflow aortocaval fistula improved right ventricular function. Aortocaval fistula is a rare complication of the abdominal aortic aneurysm. Therefore, development of reliable experimental models of chf and cardiac hypertrophy is essential to better understand disease progression and allow new therapy developement. A case of an aortocaval fistula documented by contrastenhancement computed tomography is reported. The two major etiologies of avf maturation failure are early neointimal hyperplasia development and persistent inadequate outward remodeling. In this article, the authors describe the pathogenesis, classification, and imaging of fistula in ano, with an emphasis on mr imaging. The hemodynamic changes resulting from the major shunt caused by the acf include a sudden increase in inferior vena caval pressure and volume with renal venous hypertension and a. In particular, magnetic resonance mr imaging findings have been shown to influence surgery and markedly diminish the chance of recurrence. Creating a sanitary environment in the medical imaging department.
Although the imaging findings of abdominal aortic aneurysm rupture are usually obvious, small ruptures can be mistaken for unopacified bowel, lymph node enlargement, or perianeurysmal fibrosis. The diameter and blood flow rate in the main pulmonary artery as measured by echocardiography in vivo indicated that. Murine model of central venous stenosis using aortocaval. A complication of aaas with rupture inside the ivc, aortocaval fistula, can also be imaged with ceus. Aortocaval fistula acf is an unusual complication of ruptured abdominal aortic aneurysm aaa, involving less than 36% of all ruptured cases. Aortocaval fistula is a rare complication of rupture of an aortic aneurysm into the inferior vena cava.
Imaging is the key tool for the diagnosis, management planning and followup. Imaging system visualsonics with probe rmv704 2060 mhz. Infrarenal abdominal aortic aneurysm with aortocaval fistula, a rare condition, can be fatal without prompt intervention. We report a case of aortocaval fistula demonstrated with gadoliniumenhanced magnetic resonance mr angiography. Evidence for superiority of one sequence over another is lacking, and choice depends to a degree on personal preference. Embolization of a highoutput postnephrectomy aortocaval. The reported incidence for aortocaval fistulas subsequent to an aaa is 3% to 4%. Oct 28, 2015 carotidcavernous fistulas ccfs are abnormal communications between the carotid arterial system and the venous cavernous sinus. Aortocaval fistula resulting from rupture of abdominal aortic. Aortocaval fistula is a rare and devastating complication of abdominal aortic aneurysm aaa, wherein the aneurysm erodes into the inferior vena cava. Aggravated cardiac remodeling post aortocaval fistula in. Leon, jr, bulent arslan, eleazar ley, and nicos labropoulos vascular 2007 15.
American society of radiologic technologists catalog. Endovascular repair is a valid alternative for patients with abdominal aortic aneurysms. First magnetic resonance imagingguided aortic stenting and. Aortocaval fistula acf is a rare complication of abdominal aortic aneurysm aaa. Computed tomography of primary aortocaval fistula computerized medical imaging and graphics, vol. Spontaneous rupture of an aaa into the adjacent vena cava occurs in fistula is an uncommon complication of abdominal aortic aneurysm. However, in patients with concomitant aortocaval fistulas, type ii endoleaks may result in a persistent communication between the aneurysm sac and the inferior vena cava. May 02, 2020 2015 august 8, aggravated cardiac remodeling post aortocaval fistula in unilateral nephrectomized rats, in plos one. Emergency surgery was performed in 2 cases of aortocaval fistula. Central venous pressure, however, was significantly elevated from 0. Request pdf aortocaval fistula a fistula between the inferior vena cava and aorta is a rare finding, occurring in 0. Clinical features and diagnosis of abdominal aortic aneurysm. Hematuria is an indication of rupture of an abdominal aortic aneurysm into the vena cava. First magnetic resonance imaging guided aortic stenting and cava filter placement using a polyetheretherketonebased magnetic resonance imaging compatible guidewire in swine.
Mr imaging findings of intracranial dural arteriovenous. Although the most common cause is penetrating trauma, in the setting of abdominal aortic aneurysms aaas, the incidence is aortocaval fistulas. Ceus can be helpful in haemodynamically unstable patients, imaging blood flowing from aorta to ivc 62. Proof of concept, author kos, sebastian and huegli, rolf and hofmann, eugen and quick, harald h and kuehl, hilmar and aker, stephanie and kaiser, gernot m and borm, paul j. It is important that the sequences chosen provide anatomic precision to map the fistula course and determine its relationship with other structures 7. Radiological features of uncommon aneurysms of the. Abdominal aortic aneurysm with fistula to inferior. Primary closure of the fistula was not possible, and the aneurysmal segment was excluded. Despite the superiority of avf access compared with its alternatives, avfs are still far from perfect. Aortobronchial fistula abf is a condition where there is an abnormal connection between the aorta and tracheobronchial tree translated from english by this website translates english to other languages using an automated tool.
Aortocaval fistula due to abdominal aortic aneurysm rupture. The aortocaval fistula acf model, first described in dogs almost a. Contrast mra and ct angiogram are the imaging modalities of choice for diagnosis of an aortocaval fistula, being noninvasive 3. Symptomatic acute aortocaval fistula complicating an infrarenal aortic aneurysm pevec wc, lee es, lamba r imaging nonobstetrical causes of abdominal pain in the pregnant patient mcgahan jp, lamba. Angiotensin ii control of regional haemodynamics in rats with. Endoleak, defined as contrast enhancement outside the stentgraft. Abdominal aortic aneurysm rupture with aortocaval fistula. Aortocaval fistulas are an uncommon complication of atherosclerotic aneurysms that can present with a variety of clinical symptoms. Mice with aortocaval shunt showed no differences in either blood pressure or heart rate compared to sham. A new model of congestive heart failure in the mouse due. Ephb4 regulates adaptive venous remodeling to improve. We present a patient with an abdominal aortic aneurysm. High resolution hemodynamic profiling of murine arteriovenous. The clinical presentation is often obscure, depending on the coexistence of retroperitoneal rupture and hemodynamic instability.
First magnetic resonance imagingguided aortic stenting. The presence of the fistula was only recognized during operation. Objectives the authors performed a prospective, independently adjudicated, multicenter, singlearm trial of transcaval access for tavr in patients who were ineligible for femoral artery access and had. Although rare, aortocaval fistulae have been well documented 18. Arteriovenous fistula avf is a rare complication of the abdominal aortic aneurysm aaa with complex clinical features. The pelvic mri protocol for perianal fistula evaluation consists of t1weighted and highspatialresolution t2weighted imaging sequences without fat saturation for delineation of the muscle groups, fat planes, and the fistula tract. This case study demonstrated that ultrasonography was a rapid and.
The cost effectiveness of a quickscreen program for abdominal aortic. Citeseerx document details isaac councill, lee giles, pradeep teregowda. The ct scan with contrast showed an infrarenal, 10cm aaa with atherosclerosis and. Acute renal failure as a presentation of an aortocaval fistula. T2weighted imaging with fat suppression and stir is used to assess edema and fluidcontaining tracts and. Ct findings of rupture, impending rupture, and contained. In this study, we observed the heartkidney interaction in a rat aortocaval fistula av model established at. Conservative management of persistent aortocaval fistula. Aortocaval fistula, abdominal aortic aneurysm, computed tomography ct, inferior vena cava introduction whereas the vast majority of abdominal aortic aneurysms aaa rupture into the retroperitoneum, in up to 3%5. However, ceus can also be performed under urgent conditions for the investigation of many different clinical questions.
Caudocranial scanning to evaluate bilateral ovarian arteries supplying a uterine leiomyoma. The gold standard imaging method is ct angiography, with mr angiography mra as an alternative. Since 1909, only 5 cases of a fistula between the aorta and vena cava appear to have been reported. Abbruzzese ta, guzman rj, martin rl, yee c, zarins ck, dalman rl. Aortocaval fistula associated with ruptured abdominal aortic aneurysm. A screening program for aaa in the future may detect and avoid acf in. Urgent computed tomography angiography with threedimensional reconstruction using 3mensio vascular software 3mensio medical imaging bv, bilthoven, the netherlands demonstrated a 14. The most useful imaging techniques are ct angiography, contrast enhancement ultrasound and mri angiography. Ramit lamba, radiologist in folsom, ca us news doctors. Epidemiology spontaneous rupture of an abdominal aortic aneurysm into the adjacent inferior. Clinical manifestations of aortocaval fistulas in ruptured. Background transcaval access may enable fully percutaneous transcatheter aortic valve replacement tavr without the hazards and discomfort of transthoracic transapical or transaortic access.
417 1268 30 973 265 1089 370 1409 1008 736 70 1181 261 580 179 1175 446 672 651 109 398 214 1377 1200 1035 1059 526 1231 1450 888 572 1219 14 1202 1246 323 272 350