MDT discussion of a patient with abdominal aortic aneurysm with iliac arteriovenous fistula_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YUAN Yuhang ¹ ,  DU Guocheng ^1,2

1. The Second Affiliated Medical College of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;
2. Department of Thyroid, Breast, and Vascular Surgery, Nanchong Central Hospital, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

DU Guocheng, Email: 627579436@qq.com

Keywords：

abdominal aortic aneurysm; arteriovenous fistula; intravascular treatment; diagnosis; MDT

DOI：

10.7507/1007-9424.202006020

Video：

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Objective To summarize the diagnosis and treatment experience of one case of abdominal aortic aneurysm with iliac arteriovenous fistula.Methods A case of abdominal aortic aneurysm with left iliac arteriovenous fistula admitted to Nanchong Central Hospital in December 2019 was retrospectively analyzed. The diagnosis and treatment of the patient and the MDT discussion results were summarized.Results The clinical manifestations of this patient was refractory heart failure, and he received heart medicine treatment in Nanchong Center Hospital. The patient diagnosed as abdominal aortic aneurysm with left iliac arteriovenous fistula after computed tomography angiography (CTA), abdominal aorta lumen coated stents isolation (EVAR) during operation was performed after the MDT discussion. Postoperative imaging revealed a tumor cavity abdominal aortic aneurysm and left iliac arteriovenous fistula completely closed, then the heart failure symptoms of the patient was quickly relieved. The whole operation went smoothly, with a duration of about 120 min and intraoperative blood loss of about 100 mL. The patient was discharged from hospital on the 7th day after the operation. CTA and color doppler ultrasound were rechecked in 3 months after the operation, and the stent was found to have unobtrusional blood flow and no internal leakage, and the pseudoaneurysm of the left iliac artery disappeared.Conclusions For patients with refractory heart failure, if accompanied by lower limb swelling, the possibility of arteriovenous fistula of the great vessels should be taken into account, and the medical history and physical examination should be collected comprehensively, and necessary examinations should be carried out timely to avoid missed diagnosis or misdiagnosis. Meanwhile, compared with traditional surgery, EVAR is a more reliable, minimally invasive, and safe treatment for abdominal aortic aneurysm with iliac arteriovenous fistula.

Citation： YUAN Yuhang, DU Guocheng. MDT discussion of a patient with abdominal aortic aneurysm with iliac arteriovenous fistula. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(10): 1290-1294. doi: 10.7507/1007-9424.202006020 Copy

1.	Chithra R, Sundar RA, Velladuraichi B, <italic>et al</italic>. Pediatric isolated bilateral iliac aneurysm. J Vasc Surg, 2013, 58(1): 215-216.
2.	Savastano S, Mario B, Dall’acqua J, <italic>et al</italic>. A right common iliac artery pseudoaneurysm with an iliac-caval arteriovenous fistula: a rare complication of the recovery vena cava filter. Cardiovasc Intervent Radiol, 2010, 33(3): 667-669.
3.	Vandereyken F, Schwagten V, Hertoghs M, <italic>et al</italic>. Spontaneous ilio-iliac arteriovenous fistula due to an iliac artery aneurysm: a case-report. Acta Chir Belg, 2012, 112(2): 164-166.
4.	Shah TR, Parikh P, Borkon M, <italic>et al</italic>. Endovascular repair of contained abdominal aortic aneurysm rupture with aortocaval fistula presenting with high-output heart failure. Vasc Endovascular Surg, 2013, 47(1): 51-56.
5.	Wanhainen A, Verzini F, Van Herzeele I, <italic>et al</italic>. Editor’s choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg, 2019, 57(1): 8-93.
6.	张永保, 张学民, 蒋京军, 等. 腹主动脉瘤合并髂动脉-髂静脉动静脉瘘一例. 中华普通外科杂志, 2014, 29(2): 159-160.
7.	Davis PM, Gloviczki P, Cherry KJ, <italic>et al</italic>. Aorto-caval and ilio-iliac arteriovenous fistulae. Am J Surg, 1998, 176(2): 115-118.
8.	Yamamoto Y, Kenzaka T, Kuroki S, <italic>et al</italic>. Spontaneous arteriovenous fistula of left internal iliac artery aneurysm. Eur Heart J Cardiovasc Imaging, 2015, 16(7): 817.
9.	Na SJ, Koh YS, Kim TH, <italic>et al</italic>. Iliocaval fistula presenting with paradoxical pulmonary embolism combined with high-output heart failure successfully treated by endovascular stent-graft repair: case report. J Korean Med Sci, 2014, 29(2): 296-300.
10.	Yuminaga Y, Mohabbat W, Nguyen T, <italic>et al</italic>. Simultaneous endovascular repair of an iatrogenic carotid-jugular fistula and a large iliocaval fistula presenting with multiorgan failure: a case report. J Med Case Rep, 2012, 6: 33.
11.	Nishimura S, Murakami T, Fujii H, et al. Unilateral lower extremity edema and lymphorrhea as manifestations of a ruptured iliac artery aneurysm and arteriovenous fistula. Ann Thorac Cardiovasc Surg, 2018, [Online ahead of print].
12.	胡明, 杨晗, 覃晓. 腹主动脉瘤腔内治疗与传统开放手术卫生经济学对比研究. 中国实用外科杂志, 2017, 37(12): 1390-1396.
13.	Coselli JS, Amarasekara HS, Green SY, <italic>et al</italic>. Open repair of thoracoabdominal aortic aneurysm in patients 50 years old and younger. Ann Thorac Surg, 2017, 103(6): 1849-1857.
14.	陈忠, 杨耀国. 开放手术治疗腹主动脉瘤的临床价值. 中国实用外科杂志, 2009, 29(11): 889-891.
15.	赵纪春. 杂交技术治疗胸腹主动脉瘤的体会. 中国普外基础与临床杂志, 2011, 18(10): 1027-1030.
16.	Coselli JS, LeMaire SA, Preventza O, <italic>et al</italic>. Outcomes of 3 309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg, 2016, 151(5): 1323-1337.
17.	赵纪春, 陈熹阳. 胸腹主动脉瘤的治疗进展. 中国血管外科杂志 (电子版), 2018, 10(4): 227-232.
18.	Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg, 1991, 5(6): 491-499.
19.	Spanos K, Kölbel T, Theodorakopoulou M, <italic>et al</italic>. Early outcomes of the t-branch off-the-shelf multibranched stent-graft in urgent thoracoabdominal aortic aneurysm repair. J Endovasc Ther, 2018, 25(1): 31-39.
20.	Uthoff H, Katzen BT, Gandhi R, <italic>et al</italic>. Direct percutaneous sac injection for postoperative endoleak treatment after endovascular aortic aneurysm repair. J Vasc Surg, 2012, 56(4): 965-972.
21.	Mehta M, Taggert J, Darling RC, <italic>et al</italic>. Establishing a protocol for endovascular treatment of ruptured abdominal aortic aneurysms: outcomes of a prospective analysis. J Vasc Surg, 2006, 44(1): 1-8.
22.	Djavani Gidlund K, Wanhainen A, Björck M. Intra-abdominal hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg, 2011, 41(6): 742-747.
23.	孙弘, 陈忠, 唐小斌, 等. 破裂性腹主动脉瘤腔内治疗并发症的单中心回顾性研究. 心肺血管病杂志, 2020, 39(3): 299-304.
24.	Gupta AK, Dakour-Aridi H, Locham S, <italic>et al</italic>. Real-world evidence of superiority of endovascular repair in treating ruptured abdominal aortic aneurysm. J Vasc Surg, 2018, 68(1): 74-81.

1. Chithra R, Sundar RA, Velladuraichi B, <italic>et al</italic>. Pediatric isolated bilateral iliac aneurysm. J Vasc Surg, 2013, 58(1): 215-216.
2. Savastano S, Mario B, Dall’acqua J, <italic>et al</italic>. A right common iliac artery pseudoaneurysm with an iliac-caval arteriovenous fistula: a rare complication of the recovery vena cava filter. Cardiovasc Intervent Radiol, 2010, 33(3): 667-669.
3. Vandereyken F, Schwagten V, Hertoghs M, <italic>et al</italic>. Spontaneous ilio-iliac arteriovenous fistula due to an iliac artery aneurysm: a case-report. Acta Chir Belg, 2012, 112(2): 164-166.
4. Shah TR, Parikh P, Borkon M, <italic>et al</italic>. Endovascular repair of contained abdominal aortic aneurysm rupture with aortocaval fistula presenting with high-output heart failure. Vasc Endovascular Surg, 2013, 47(1): 51-56.
5. Wanhainen A, Verzini F, Van Herzeele I, <italic>et al</italic>. Editor’s choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg, 2019, 57(1): 8-93.
6. 张永保, 张学民, 蒋京军, 等. 腹主动脉瘤合并髂动脉-髂静脉动静脉瘘一例. 中华普通外科杂志, 2014, 29(2): 159-160.
7. Davis PM, Gloviczki P, Cherry KJ, <italic>et al</italic>. Aorto-caval and ilio-iliac arteriovenous fistulae. Am J Surg, 1998, 176(2): 115-118.
8. Yamamoto Y, Kenzaka T, Kuroki S, <italic>et al</italic>. Spontaneous arteriovenous fistula of left internal iliac artery aneurysm. Eur Heart J Cardiovasc Imaging, 2015, 16(7): 817.
9. Na SJ, Koh YS, Kim TH, <italic>et al</italic>. Iliocaval fistula presenting with paradoxical pulmonary embolism combined with high-output heart failure successfully treated by endovascular stent-graft repair: case report. J Korean Med Sci, 2014, 29(2): 296-300.
10. Yuminaga Y, Mohabbat W, Nguyen T, <italic>et al</italic>. Simultaneous endovascular repair of an iatrogenic carotid-jugular fistula and a large iliocaval fistula presenting with multiorgan failure: a case report. J Med Case Rep, 2012, 6: 33.
11. Nishimura S, Murakami T, Fujii H, et al. Unilateral lower extremity edema and lymphorrhea as manifestations of a ruptured iliac artery aneurysm and arteriovenous fistula. Ann Thorac Cardiovasc Surg, 2018, [Online ahead of print].
12. 胡明, 杨晗, 覃晓. 腹主动脉瘤腔内治疗与传统开放手术卫生经济学对比研究. 中国实用外科杂志, 2017, 37(12): 1390-1396.
13. Coselli JS, Amarasekara HS, Green SY, <italic>et al</italic>. Open repair of thoracoabdominal aortic aneurysm in patients 50 years old and younger. Ann Thorac Surg, 2017, 103(6): 1849-1857.
14. 陈忠, 杨耀国. 开放手术治疗腹主动脉瘤的临床价值. 中国实用外科杂志, 2009, 29(11): 889-891.
15. 赵纪春. 杂交技术治疗胸腹主动脉瘤的体会. 中国普外基础与临床杂志, 2011, 18(10): 1027-1030.
16. Coselli JS, LeMaire SA, Preventza O, <italic>et al</italic>. Outcomes of 3 309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg, 2016, 151(5): 1323-1337.
17. 赵纪春, 陈熹阳. 胸腹主动脉瘤的治疗进展. 中国血管外科杂志 (电子版), 2018, 10(4): 227-232.
18. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg, 1991, 5(6): 491-499.
19. Spanos K, Kölbel T, Theodorakopoulou M, <italic>et al</italic>. Early outcomes of the t-branch off-the-shelf multibranched stent-graft in urgent thoracoabdominal aortic aneurysm repair. J Endovasc Ther, 2018, 25(1): 31-39.
20. Uthoff H, Katzen BT, Gandhi R, <italic>et al</italic>. Direct percutaneous sac injection for postoperative endoleak treatment after endovascular aortic aneurysm repair. J Vasc Surg, 2012, 56(4): 965-972.
21. Mehta M, Taggert J, Darling RC, <italic>et al</italic>. Establishing a protocol for endovascular treatment of ruptured abdominal aortic aneurysms: outcomes of a prospective analysis. J Vasc Surg, 2006, 44(1): 1-8.
22. Djavani Gidlund K, Wanhainen A, Björck M. Intra-abdominal hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg, 2011, 41(6): 742-747.
23. 孙弘, 陈忠, 唐小斌, 等. 破裂性腹主动脉瘤腔内治疗并发症的单中心回顾性研究. 心肺血管病杂志, 2020, 39(3): 299-304.
24. Gupta AK, Dakour-Aridi H, Locham S, <italic>et al</italic>. Real-world evidence of superiority of endovascular repair in treating ruptured abdominal aortic aneurysm. J Vasc Surg, 2018, 68(1): 74-81.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

MDT discussion of a patient with abdominal aortic aneurysm with iliac arteriovenous fistula

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