Endovascular treatment of an Aorto-caval fistula caused by a late type 2 endoleak

Aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysms (AAA) and involves less than 1% of all AAAs; this number increases from 2 to 6.7% in ruptured AAAs. Unlike other aortic ruptures, most aortocaval fistulas are not associated with significant blood loss upon admission. The traditional treatment strategy has been open surgery, which is associated with a high mortality rate. Endovascular repair has been performed, but results are difficult to interpret due to the low incidence of ACF and the absence of cases published with a long follow-up. A 78-year-old male with previous EVAR in 2015, presented to our emergency department 6 years later with abdominal pain. A computed tomography angiography scan showed type IA, IB, and II endoleaks as well as an ACF. The endoleaks were selectively treated and the ACF was covered with a PTFE endograft inserted in the inferior vena cava (IVC). In our single-case experience with a medium-term follow-up (24 months), our treatment was safe and effective for ACF closure and there were no further signs of endoleak or graft thrombosis. We conducted a literature review of reported cases in which a covered stent graft was used for ACF treatment. Although there are currently no guidelines regarding this rare late complication after EVAR, using an IVC-placed covered stent to treat an ACF could be a viable option in selected cases.