Endovascular Aneurysm Repair (EVAR) in a Patient with an Aortocaval Fistula / 日本心臓血管外科学会雑誌

ABSTRACT

We report a case of endovascular aneurysm repair (EVAR) in a patient with an aortocaval fistula (ACF) who presented with congestive heart failure due to left-to-right shunting. The patient was an 80-year-old man who complained of sudden respiratory discomfort and lower leg edema, and was admitted to the emergency department. The initial diagnosis on admission was acute heart failure. Because the inferior vena cava was visualized by angiography in the arterial phase due to the fistula from the abdominal aorta, after admission, we rediagnosed this case as ACF. As medical treatment did not improve the patient's symptoms, emergency surgery was decided upon. Because preoperative evaluation was able to rule out the existence of an aortic aneurysm, ACF closure was performed by EVAR. The postoperative course was uneventful and the patient was discharged 15 days after surgery. ACF without aortic aneurysm is uncommon and is not easily diagnosed. This case demonstrated that EVAR can be an effective treatment option for ACF.