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This article is part of the supplement: Selected articles from the XXV National Congress of the Italian Society of Geriatric Surgery

Open Access Research article

Percutaneous treatment of a aorto-caval fistula in a old high risk patient

Antonio Rapacciuolo1, Maria Carmen De Angelis1, Elisa di Pietro1, Roberto Puglia1, Ettore Di Tommaso1*, Danilo Ruggiero1, Bruno Amato2 and Gabriele Iannelli1

Author affiliations

1 Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University of Naples, Italy

2 Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, University “Federico II” of Naples, Italy

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Citation and License

BMC Surgery 2012, 12(Suppl 1):S32  doi:10.1186/1471-2482-12-S1-S32

Published: 15 November 2012

Abstract

Background

To remark the feasibility of endovascular treatment of an aorto-caval fistula in a old high risk patient with “hostile” abdomen for previous surgeries.

Methods

In September 2009 a 81-years-old patient was admitted in emergency at our department because of abdominal pain and massive oedema of the lower extremities associated to dyspnoea (New York Heart Association (NYHA) functional class III). A CT scan showed an aorto-caval fistula involving the abdominal aorta below the renal arteries. This abnormal communication was likely due to the previous abdominal surgeries, was complicated by occlusion of the inferior vena cava at the diaphragm and was responsible for the massive oedema of the lower extremities. Because of unstable conditions and hostile abdomen the patient was considered unfit for conventional surgery and an endovascular approach was planned. After unsuccessful attempt by positioning of an Amplatzer vascular ring into the fistula, a Medtronic covered stent-grafts were implanted from the renal arteries to the both common iliac arteries. The patient had an impressive improvement characterized by a 18 Kg weight loss and a complete restoration of the functional capacity (from NYHA class III to NYHA class I) associated to a complete resolution of the lower extremities oedema as confirmed at the a month-CT-scan.

Conclusion

Endovascular surgery of aorto-caval fistula represents a good option in alternative to conventional surgery mostly in old high risk patient.