J Korean Med Sci.  2014 Feb;29(2):296-300. 10.3346/jkms.2014.29.2.296.

Iliocaval Fistula Presenting with Paradoxical Pulmonary Embolism Combined with High-Output Heart Failure Successfully Treated by Endovascular Stent-Graft Repair: Case Report

• Na SJ
• Koh YS
• Kim TH
• Park SC
• Shin WS
• Chun HJ
• Lee JM

• KMID: 1789992
• DOI: http://doi.org/10.3346/jkms.2014.29.2.296

Abstract

A 51-yr-old man presented exertional dyspnea as a consequence of iliocaval fistula combined with paradoxical pulmonary embolism and high-output heart failure. Endovascular stent-graft repair was performed to cover iliocaval fistula and restore the heart function. After the procedure, dyspnea was improved and procedure related complication was not seen. A 6-month follow-up computed tomography showed regression of pulmonary thromboembolism and well-positioned stent-graft without graft migration, aortacaval communication or endoleak. Stent graft implantation should be considered an alternative of open repair surgery for treament of abdominal arteriovenous fisula, especially in patient with high risk for surgery.

Keyword

Arteriovenous Fistula; Pulmonary Embolism; Angioplasty

MeSH Terms

Dyspnea/diagnosis
Endovascular Procedures
Fistula/complications/*diagnosis
Heart Failure/complications/*diagnosis/surgery
Humans
Iliac Vein
Male
Middle Aged
Pulmonary Embolism/complications/*diagnosis/surgery
*Stents
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Contrast-enhanced abdominal CT images. (A-C) Images at diagnosis showed 40×38 mm sized right iliac artery aneurysm and iliocaval fistula (black arrow) with thrombus (white arrows). (D-F) Follow-up images at 6 months after endovascular stent-graft repair demonstrated patency of the graft, without evidence of graft migration or aortocaval communication. (A, D) Transverse veiw; (B) Coronal view; (C) Sagittal view; (E) Coronal maximal intensity projection view; (F) Sagittal maximal intensity projection view.

• 

  Fig. 2 Contrast-enhanced chest CT images. (A, B) Images at diagnosis showed pulmonary thromboembolism (arrows) that involved right lower lobe base segmental pulmonary artery. (C, D) Follow-up chest CT scans at 6 months after coumadization showed much regressed pulmonary embolism. (A, C) Arterial phase; (B, D) Venous phase.

• 

  Fig. 3 Angiography findings. (A) Embolization of right common iliac artery was performed with PLUG 10 mm (dotted arrow). (B) Pelvic arteriogram showed aneurysmal dilatation of right common iliac artery, iliocaval shunt and some filling defects near the aneurysm (white arrow indicate thrombus). (C) Angiography after deployment of the stents showed well implanted graft stents and no visible of IVC.

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