Successful Endovascular Treatment of Bleeding Aortoenteric Fistula: A Case Report

Aortoenteric fistula (AEF) is an infrequent but disastrous complication of open abdominal aortic repair. Left untreated, it has a 100% fatality rate. The traditional approaches to the repair of secondary AEF (SAEF) are associated with average mortality rates of 21-59% and numerous major complications. Here, we report a case of acute gastrointestinal bleeding due to SAEF, successfully treated with endovascular stent graft repair. At 1-year follow-up, the patient was doing well without any signs of recurrent fistula. Endovascular treatment of AEF provides another treatment option that may be particularly valuable in patients whose comorbidities would preclude open repair.     

海绵窦区硬脑膜动静脉瘘患者血管内栓塞治疗的护理

目的 探讨海绵窦区硬脑膜动静脉瘘患者血管内栓塞治疗的护理.方法 对13例海绵窦区硬脑膜动静脉瘘患者行血管内栓塞治疗;术前做好眼部护理、心理护理,术后密切观察病情变化、注意体位护理,饮食护理及并发症的护理.结果 10例患者瘘口完全消失;3例栓塞后瘘口残余,予颈动脉压迫治疗后2例瘘口消失;平均住院治疗18.3 d出院.结论 血管内栓塞治疗海绵窦区硬脑膜动静脉瘘效果较好,优质的围术期护理可保证治疗效果.     

Successful Treatment of an Aorto-Ileal-Conduit Fistula with an Endovascular Stent Graft: Report of a Case

A 55-year-old man presented with a massive hemorrhage from the ileal conduit of the left ureter. He had previously undergone a total pelvic exenteration with ileal conduit construction of the ureters due to rectal carcinoma. A right ureteroarterial fistula developed, and he underwent an excision of the right common iliac artery with a femorofemoral bypass and a right cutaneous ureterostomy. Seven months later, a pseudoaneurysm developed at the aortic stump, followed by an aorto-ileal-conduit fistula. The patient was treated successfully with endovascular stent grafting and has since showed a good recovery no sign of graft infection or a recurrence of hematuria at the 10-month follow-up.     

Endovascular Repair of a Ruptured Popliteal Artery Aneurysm Associated with Popliteal Arteriovenous Fistula

Popliteal artery aneurysms (PAAs) represent the most common peripheral arterial aneurysm and are a significant cause of patient morbidity and limb loss. Complications of PAA include distal embolisation, thrombosis and, rarely, rupture. Whereas open surgical repair remains the gold standard, endovascular exclusion has been demonstrated to be a valid alternative in selected patients.We present an unusual case of ruptured PAA associated with popliteal vein arteriovenous fistula that was successfully treated with an endovascular approach.In our opinion, higher-risk patients as well as patients presenting with rupture may constitute a subgroup warranting an endovascular approach whenever possible.     

Endovascular Stent Graft Treatment of a Traumatic Aortocaval Fistula

Aortocaval fistula (ACF) is an infrequently reported sequela of trauma. Most ACF have been repaired via an open approach. During the past 10 years, there has been one reported case of spontaneous ACF and two cases of traumatic ACF repaired using an endovascular technique. We present a third case of traumatic ACF repaired with an endovascular stent graft. A 40-year-old male sustained two gunshot wounds to the right chest and one to the right upper abdomen. He was taken from the emergency department directly to the operating room, where an exploratory laparotomy was performed. Through-and-through injuries to the stomach and transverse colon were repaired primarily. Subsequently, the patient developed abdominal compartment syndrome. An urgent exploratory laparotomy was performed, revealing a nonbleeding hematoma on the posterior lateral surface of the right lobe of the liver, which was left undisturbed. Open abdominal management was instituted with vacuum pack closure. On the nineteenth hospital day, the patient again had a significant decrease in hematocrit. An aortogram was performed in order to evaluate the patient for intrahepatic arterial bleeding amenable to transcatheter embolization. There was no evidence of hepatic arterial bleeding. However, a supraceliac ACF was identified. The patient was taken to the operating room, and an AneuRx aortic extension cuff was advanced under fluoroscopy and deployed to cover the fistula. Completion angiography revealed total obliteration of the ACF and appropriate placement of the stent graft. Postoperatively, the patient was returned to the intensive care unit, where his hospital course was complicated by ventilator-associated pneumonia and sepsis. Repeat computed tomographic scanning 6 months and 1 year following this repair demonstrated patency of the graft without evidence of graft migration or aortocaval communication. Further research and experience are necessary with this technique regarding long-term outcome and technical aspects. In particular, the sizing problems associated with repair of acute traumatic ACF in emergency situations should be addressed. The endovascular approach provides an attractive and exciting alternative to traditional methods for repair of ACF.     

弹簧钢圈治疗右肾动静脉瘘(附1例报告)

我们用弹簧钢圈栓塞右肾动静脉瘘 1例 ,国内罕见报道 ,现报告如下材料与方法　　病例 ,男 ,37岁 ,1年前无明显诱因出现右侧腰背部酸胀不适 ,外院彩色超声多谱勒检查为肾脏血管瘤 ,拟行右肾切除术 ,入院后予常规抗炎止痛等对症治疗后 ,症状减轻。查体 :右肋脊角处可闻及收缩期吹风样杂音 ,响度不超过Ⅱ级。彩色超声多谱勒提示 :右肾 10 .9ｃｍ× 5 .5ｃｍ ,形态饱满 ,被膜光滑 ,皮髓质分界清。肾窦及肾门至下腔静脉段肾静脉扩张 ,肾窦宽约2 .4ｃｍ ,肾门宽约 1.8ｃｍ ;扩张的静脉内血流呈红蓝相间的漩涡状 ,多谱勒示连续湍流频谱。肾门处肾动…     

Successful Endovascular Stent-Graft Treatment for an Aortoesophageal Fistula Caused by a Descending Thoracic Aortic Aneurysm: Report of a Case

Conventional surgery for aortoesophageal fistula (AEF) is technically difficult, and is associated with high morbidity and mortality. We report a case of primary AEF caused by a descending thoracic aortic aneurysm, which was successfully treated with an endovascular stent-graft technique. The patient has been followed up for 3 years with no signs of infection.     

Endovascular Repair of a Traumatic Arteriovenous Fistula 34 Years After the Injury: Report of a Case

Penetrating extremity injuries can result in the development of arteriovenous fistulas (AVFs), whereby normal blood flow through the capillary bed is bypassed. Late complications of untreated AVFs include proximal arterial dilatation, venous congestion, congestive heart failure, and distal ischemia. We report the case of a 57-year-old man who was referred to us for treatment of a traumatic AVF with multiple sequelae, 34 years after he sustained a shrapnel injury to his right lower leg. We performed successful endovascular repair of this AVF with the patient under spinal anesthesia. Computed tomographic angiography (CTA) done 1 month and 6 months later confirmed AVF exclusion. Patients may present with sequelae of traumatic AVFs many years after their initial injury. Endovascular repair of AVFs offers several advantages over conventional repair and can be performed successfully even in the presence of complex anatomic abnormalities.     

Traumatic Arteriovenous Fistula

Traumatic arteriovenous fistula in the head and neck may present a difficult problem in management. We present a surgical case of traumatic arteriovenous fistula between the right subclavian artery and internal jugular vein with false aneurysm formation. Traumatic injury of the subclavian artery causing arteriovenous fistula with false aneurysm is a serious surgical emergency with appreciable morbidity and mortality that requires early recognition and prompt surgical intervention.     

Coronary Arteriovenous Fistula

A coronary artery fistula to the coronary sinus in a 58-year-old woman with angina pectoris is described. Two big fistulas from the right coronary artery had a common opening which was closed with 5 mattress sutures buffered with teflon pearls and a dacron patch. A small fistula between the left coronary artery and the coronary sinus was closed with 2 mattress sutures. An atrial septal defect was also encountered and closed. The patient survived the operation and is now free of angina pectoris.