Skip to main content

Advertisement

SpringerLink
Log in

Endovaskuläre Therapie des infrarenalen Bauchaortenaneurysmas mit aortokavaler Fistel

Eigene Erfahrungen und Darstellung der Literaturberichte

Endovascular therapy of infrarenal aortic aneurysms with aortocaval fistula

Our experiences and literature review

  • Übersichtsarbeiten
  • Published:
Gefässchirurgie Aims and scope Submit manuscript

Zusammenfassung

Eine aortokavale Fistel ist eine seltene Manifestation eines rupturierten infrarenalen Bauchaortenaneurysmas mit einer Häufigkeit von 3–6%. Klinische Symptome sind der abdominelle Schmerz mit venöser Einflussstauung und Tachykardie, meist rascher kardialer Dekompensation mit zunehmender Dyspnoe und einem auskultierbaren abdominellen Maschinengeräusch. Häufig wird der Befund einer aortokavalen Fistel erst intraoperativ im Rahmen der offenen Aneurysmaausschaltung gestellt. Die Letalität des offenen operativen Eingriffs ist mit 20–60% hoch. Es wird über die Erfahrungen mit der endovaskulären Therapie von Patienten mit infrarenalem Aneurysma und aortokavaler Fistel und die bisherigen Mitteilungen in der Literatur berichtet. Die endovaskuläre Therapie mit Implantation eines Y-Stentgrafts stellt bei Patienten mit infrarenalem Aortenaneurysma, aortokavaler Fistel und geeigneter Aortenkonfiguration eine neue operative Therapieoption dar.

Abstract

An aortocaval fistula is a rare complication of a symptomatic or ruptured infrarenal aortic aneurysm having a frequency of 3–6%. Patients typically present with clinical signs of diffuse abdominal pain associated with increasing venous congestion and tachycardia, rapid cardiopulmonary decompensation with acute dyspnea and an audible machinery-like bruit. Frequently, the diagnosis is obtained only during open aneurysm repair. Perioperative mortality is high, ranging from 20% to 60%. We report our experience with endovascular aortic repair in patients with symptomatic infrarenal aortic aneurysms and aortocaval fistula, and review the literature. Endovascular stent graft implantation seems to be a promising new treatment option for patients with abdominal aortic aneurysms, rupture into the inferior vena cava, and aortoiliac configurations acceptable for endovascular therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Abbadi AC, Deldime PP, Van Espen D, Simon M, Rosoux P (1998) The spontanous aortocaval fistula: a complication of the abdominal aortic aneurysm. Case report and review of the literature. J Cardiovasc Surg 39: 433–436

    Google Scholar 

  2. Alexander JJ, Imbembo AL (1989) Aorta-vena cava fistula. Surgery 105: 1–12

    PubMed  Google Scholar 

  3. Beveridge CJ, Pleass HC, Chamberlain J, Wyatt MG, Rose JD (1998) Aortoilliac aneurysm with arteriocaval fistula treated by a bifurcated endovascular stent-graft. Cardiovasc Intervent Radiol 21: 244–246

    Article  PubMed  Google Scholar 

  4. Burke C, Mauro MA (2003) SIR film panel case 8: aortocaval fistula supplied by a type II endoleak. J Vasc Interv Radiol 14: 813–817

    PubMed  Google Scholar 

  5. Brewster DC, Cambria RP, Moncure AC et al. (1991) Aortocaval and iliac arteriovenous fistulas: recognition and treatment. J Vasc Surg 13: 253–265

    Article  PubMed  Google Scholar 

  6. Brunkwall J, Länne T, Bergentz SE (1999) Acute renal impairment due to a primary aortocaval fistula is normalised after a successful operation. Eur J Vasc Endovasc Surg 17: 191–196

    Article  PubMed  Google Scholar 

  7. Calligaro KD, Savarese RP, De Laurentis DA (1990) Unusual aspects of aortovenous fistulas associated with ruptured abdominal aortic aneurysms. J Vasc Surg 12: 586–590

    Article  PubMed  Google Scholar 

  8. Cooley DA (1955) Diskussionsbeitrag zu: David M, Dye WS, Grove JW, Julian OC (1955) Resection of ruptured aneurysms of the abdominal aorta. Ann Surg 142: 623

    Google Scholar 

  9. Davidovic LB, Kostic DM, Cvetkovic SD et al. (2002) Aorto-caval fistulas. Cardiovasc Surg 10: 555–560

    Article  PubMed  Google Scholar 

  10. Davis PM, Gloviczki P, Cherry KJ et al. (1998) Aorto-caval and ilio-iliac arteriovenous fistulae. Am J Surg 176: 115–118

    Article  PubMed  Google Scholar 

  11. Ellis PK, Kennedy PT, Collins AJ, Blair PH (2003) The use of direct thrombin injection to treat a type II endoleak following endovascular repair of abdominal aortic aneurysm. Cardiovasc Intervent Radiol 26: 482–484

    Article  PubMed  Google Scholar 

  12. EVAR trial participants (2005) Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 365: 2179–2186

    Article  PubMed  Google Scholar 

  13. Faries PL, Cadot H, Agarwal G, Kent KG, Hollier LH, Marin ML (2003) Management of endoleak after endovascular aneurysm repair: cuffs, coils, and conversion. J Vasc Surg 37: 1155–1161

    Article  PubMed  Google Scholar 

  14. Fenster MS, Dent JM, Tribble C et al. (1996) Aorto caval fistula complicating abdominal aortic aneurysm: case report and literature review. Cathet Cardiovasc Diagn 38: 75–79

    Article  PubMed  Google Scholar 

  15. Gandini R, Ippoliti A, Pampana E, Marchetti AA, Pistolese RG, Simonetti G (2002) Emergency endograft placement for recurrent aortocaval fistula after conventional AAA repair. J Endovasc Ther 9: 208–211

    Article  PubMed  Google Scholar 

  16. Greenberg RK, Srivastava SD, Ouriel K et al. (2000) An endoluminal method of hemorrhage control and repair of ruptured abdominal aortic aneurysms. J Endovasc Ther 38: 75–79

    Google Scholar 

  17. Gilling-Smith GL, Mansfield AO (1991) Spontanous abdominal arteriovenous fistula: report of eight cases and review of the literature. Br J Surg 78: 421–425

    PubMed  Google Scholar 

  18. Ghilardi G, Scorza R, Bartolini E, de Monti M, Longhi F, Ruberti U (1993) Rupture of abdominal aortic aneurysms into major abdominal veins. J Cardiovasc Surg 34: 39–47

    Google Scholar 

  19. Hinchliffe RJ, Singh-Ranger R, Davidson IR, Hopkinson BR (2001) Rupture of an abdominal aortic aneurysm secondary to type II endoleak. Eur J Vasc Endovasc Surg 22: 563–565

    Article  PubMed  Google Scholar 

  20. Lau LL, O’Reilly MJ, Johnston LC, Lee B (2001) Endovascular stent-graft repair of primary aortocaval fistula with an abdominal aortoiliac aneurysm. J Vasc Surg 33: 425–428

    Article  PubMed  Google Scholar 

  21. Miani S, Giorgetti PL, Arpesani A, Giuffrida GF, Biasi GM, Ruberti U (1994) Spontanous aorto-caval fistulas from ruptured abdominal aortic aneurysm. Eur J Vasc Surg 8: 36–40

    Article  PubMed  Google Scholar 

  22. Parodi JC, Schonholz C, Ferreira LM (1999) Endovascular stent-graft treatment of traumatic arterial lesions. Ann Vasc Surg 13: 121–129

    Article  PubMed  Google Scholar 

  23. Sheehan MK, Barbato J, Compton CN, Zajko A, Rhe R, Makaroun S (2004) Effectiveness of coiling in the treatment of endoleaks after endovascular repair. J Vasc Surg 40: 430–434

    Article  PubMed  Google Scholar 

  24. Steinmetz E, Rubin BG, Sanchez LA et al. (2004) Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost-effective. J Vasc Surg 39: 306–313

    Article  PubMed  Google Scholar 

  25. Schmidt R, Bruns C, Walter M, Erasmi H (1994) Aorto-caval fistula – an uncommon complication of infrarenal aortic aneurysms. Thorac Cardiovasc Surg 42: 208–211

    PubMed  Google Scholar 

  26. Sollis MM, Ayerdi J, Babcock GA et al. (2002) Mechanism of failure in the treatment of type II endoleak with percutanous coil embolization. J Vasc Surg 36: 485–491

    Article  PubMed  Google Scholar 

  27. Syme J (1831) Case of spontanous varicose aneurysm. Edin Med J 36: 104–105

    Google Scholar 

  28. Umscheid T, Stelter WJ (2000) Endovascular treatment of an aortic aneurysm ruptured into the inferior vena cava. J Endovasc Ther 7: 31–35

    Article  PubMed  Google Scholar 

  29. White GH, Yu W, May J, Chaufour X, Stephen MS (1997) Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysm: classification, incidence, diagnosis, and management. J Endovasc Surg 4: 152–168

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Klinikum Großhadern der LMU München

    R. Weidenhagen, G. Meimarakis & K. W. Jauch

  2. Institut für Klinische Radiologie, Klinikum Großhadern der LMU München

    R. Hoffmann

  3. Institut für Anästhesiologie, Klinikum Großhadern der LMU München

    S. Czerner, P. Bernasconi & L. Frey

  4. Chirurgische Klinik, Städtische Kliniken, Frankfurt am Main – Höchst

    T. Umscheid & W. Stelter

  5. Chirurgische Klinik und Poliklinik – Großhadern, Klinikum der LMU München, Marchioninistr. 15, 81377, München

    R. Kopp

Authors
  1. R. Kopp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Weidenhagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Meimarakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Czerner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T. Umscheid
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Bernasconi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. L. Frey
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. K. W. Jauch
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. W. Stelter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Kopp.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kopp, R., Weidenhagen, R., Meimarakis, G. et al. Endovaskuläre Therapie des infrarenalen Bauchaortenaneurysmas mit aortokavaler Fistel. Gefässchirurgie 11, 100–107 (2006). https://doi.org/10.1007/s00772-006-0451-6

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00772-006-0451-6

Schlüsselwörter

Keywords

Search

Navigation