Aorto-caval fistula from acute rupture of an abdominal aortic aneurysm treated with a hybrid approach.

Abstract

Ruptured abdominal aneurysm is a life-threatening disease requiring immediate treatment. The outcome is even worse in cases complicated by aorto-caval fistula. Treatment is usually attempted by open surgery using direct closure of the venous tear and graft placement in the aorta. Interventional treatment in certain patients seems sensible and has been reported. We report a patient who experienced the rupture of a 13-cm infrarenal aneurysm into the inferior vena cava. He developed signs of severe heart failure and congestion of the lower half of the body. Diagnosis was confirmed by computed tomography (CT)-scan. Due to anatomy unsuitable for endovascular treatment and the potential bleeding complications associated with open surgery involving a big fistula, we decided to close the fistula with a covered stent in the vena cava and operated on the aortic rupture immediately thereafter. The ease of this hybrid approach justifies suggesting it as a possible treatment option for this severe disease.