Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.200174
Jornal Vascular Brasileiro
Case Report

Abdominal aortic aneurysms ruptured to the vena cava: a case series and literature review

Aneurismas de aorta abdominal rotos para a veia cava: uma série de casos e revisão de literatura

Carolina de Oliveira; Bruno Pagnin Schmid; Giovani José Dal Poggetto Molinari; Ana Terezinha Guillaumon

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Abstract

Abstract: Ruptured abdominal aortic aneurysms (RAAA) evolving aortocaval fistula (AF) can have catastrophic hemodynamic effects. Surgical repair is imperative, but the optimal technical approach is still under debate. Our objective is to present 3 cases treated with endovascular repair (EVAR) at a University Hospital. Case #1, a 71-year-old man presenting a 7.1cm RAAA with AF, repaired with a monoiliac stent graft and femoral-femoral bypass; Case #2, a 76-year-old man presenting a 9.9cm RAAA with AF, repaired with a bifurcated stent graft; Case #3, a 67-year-old man with previous history of EVAR, presenting a type 3 endoleak with late rupture related to AF, repaired with a tubular stent graft. All cases unfolded with delayed recovery and significant complication rates, although AF symptoms had resolved by hospital discharge. EVAR techniques for AF may require secondary interventions but are feasible, despite the lack of consensus, considering the rarity of this RAAA presentation.

Keywords

aneurysm, ruptured, aortic aneurysm, abdominal, arteriovenous fistula, case series, vascular fistula

Resumo

Resumo: Aneurismas de aorta abdominal rotos (AAAR) com evolução para fístula aorto-cava (FAC) podem apresentar consequências hemodinâmicas catastróficas. A correção cirúrgica é mandatória, embora não haja consenso sobre a técnica operatória. Apresentamos uma série de três casos operados em hospital universitário pela técnica endovascular. No primeiro caso, um homem de 71 anos apresentou AAAR de 7,1 cm com FAC, submetido a correção por endoprótese monoilíaca e enxerto femoral cruzado. No segundo, um homem de 76 anos apresentou AAAR de 9,9 cm com FAC submetido a colocação de endoprótese bifurcada. O terceiro caso era de um homem de 67 anos com histórico de EVAR e endoleak tipo 3, com ruptura tardia para veia cava, tratado com extensão aórtica. Todos apresentaram evolução pós-operatória prolongada com significativas complicações, entretanto com boa resolução dos sintomas à alta hospitalar. A EVAR é uma técnica promissora para o tratamento de FAC, embora com taxa de reintervenção significativa.
 

Palavras-chave

ruptura aórtica, aneurisma aórtico, fístula vascular, relatos de casos, fístula arteriovenosa

References

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Submitted date:
09/13/2020

Accepted date:
11/25/2020

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