Keywords
aortic valve replacement - aortocaval fistula - endovascular treatment
A 61-year-old man with medical history of hypertension, smoking, and aortic valve
replacement 5 years ago with a size 23 mechanical St. Jude aortic prosthesis presented
with a 4-day history of lower abdominal pain and hemodynamic compromise. Abdominal
examination revealed a tender, pulsatile aorta, and blood tests revealed acute renal
failure. An urgent computed tomographic scan was performed. It revealed a dissection
of the ascending aorta ([Fig. 1]) with a large abdominal aortic aneurysm ([Fig. 2]) associated with an aortocaval fistula ([Fig. 3]). An endovascular treatment was proposed given the anticoagulated state (international
normalized ratio at 2.75), but the patient died after a rapid deterioration of his
hemodynamic status. We suppose that the aortic dissection, which was probably due
to the past cardiac surgery, was the primary cause of the dissecting aneurysm of the
abdominal aorta, which was subsequently complicated by aortocaval fistula.[1] In such a case, endovascular treatment has its place, given the severity of the
patient's hemodynamic status and the surgical difficulty[2] due to the primary pathology and the anticoagulated state.
Fig. 1 Sagittal computed tomography (CT) scan that documents aortic dissection (Type A)
and aortic aneurysm. 1, aortic dissection with the true and the false channel; 2,
aortic aneurysm.
Fig. 2 Coronal reconstruction showing aneurysm of the aorta with early opacification of
the inferior vena cava secondary to the aortocaval fistula. 1, nonaneurysmal aorta;
2, aneurysmal aorta; 3, inferior vena cava.
Fig. 3 Axial section of the aortocaval fistula. 1, aorta; 2, fistula; 3, inferior vena cava.
