RESUMO
An arteriovenous fistula (AVF) is an uncommon sequela of spontaneous arterial aneurysm rupture into the adjacent venous system. We describe the case of a 74-year-old patient who underwent endovascular treatment of a right iliac AVF caused by a ruptured common iliac artery (CIA) aneurysm and a distal left CIA aneurysm. Surgery preserved the lumbar and inferior mesenteric arteries because of the need to simultaneously exclude the hypogastric arteries. Dynamic fluid balance phenomena provoked by closure of the AVF are described. The patient had a benign postoperative course with normalization of the severe hemodynamic changes presented prior to the intervention and resolution of respiratory symptoms attributed to pulmonary arterial hypertension.
RESUMO
PURPOSE: This study was performed to evaluate the authors' experience with the endovascular treatment of abdominal aortic aneurysm (AAA) with use of a self-expanding nitinol stent covered with a polyester fabric device and to report the implant's technical features, the immediate results, and the outcome 30 days after device implantation. MATERIALS AND METHODS: From June 1997 to December 2001, we admitted 169 patients diagnosed with AAA. Of these, 134 were suitable to undergo endovascular repair with use of the Talent stent-graft. In one patient, it was technically impossible to proceed with the implantation procedure. Therefore, a total of 133 patients were treated with use of this technique (78.7%). The average age was 70.7 years (range, 52-88 y). There were 119 men and 14 women. Computed tomographic follow-up was done between the 15th and 30th postoperative days. RESULTS: The stent-grafts were successfully implanted in all 133 patients. Complications during the procedure included three type-I endoleaks (2.3%) and four iliac artery ruptures (3.0%), which were effectively treated by means of aortic or iliac extension grafts, respectively. The average surgical time was 2.92 hours (from 1.67 h to 7 h). Of the stent-grafts used, 125 were bifurcated (94.0%), two were straight tube grafts (1.5%), and six were conical aortouniiliac grafts (4.5%). Custom-made grafts were used in 62 patients (46.6%) and standard grafts were used in 71 (53.4%). Suprarenal fixation was performed in 117 patients (88%). One female patient developed a serious pulmonary embolism. Eight patients (6.0%) developed serious systemic inflammatory syndrome; two died of disseminated intravascular coagulopathy. There were two additional deaths, one from refractory shock and one suddenly from an unknown cause (total mortality rate, 3.0%). During the postoperative period, 70.3% of the patients developed mild fever (37.6 degrees C-38.9 degrees C). The average length of stay in the intensive care unit was 1.3 days (ranging from 1 d to 12 d) and the total hospitalization time was 4.2 days. Six type-II endoleaks were observed: two were corrected by video laparoscopy-assisted inferior mesenteric artery interruption and the other four were clinically followed up. CONCLUSIONS: The exclusion of AAA by endovascular techniques with use of the Talent device was possible in the majority of cases with a low incidence of complications. The most common serious postprocedural complication was systemic inflammatory syndrome.