case_images: PMC11821926_01
case_images: (A) The preoperative computed tomography angiography (CTA) showed a large abdominal aortic aneurysm (AAA) with associated aortocaval fistula (ACF, white arrowheads). (B) Three-dimensional reconstruction CTA showed an angulated aneurysm and tortuous aorto-iliac access. The maximum diameter of the AAA was approximately 8.7 cm. (C) The preoperative CTA showed bilateral internal iliac artery aneurysms (white arrowheads). The maximum diameter of the left internal iliac artery is approximately 32 mm, and the maximum diameter of the right internal iliac artery is approximately 34 mm.
case_images: fcvm-12-1518025-g001.jpg
case_images: PMC11821926_01_fcvm-12-1518025-g001.jpg
case_images: F1
case_images: During the arterial phase, the rapid contrast early filling of the inferior vena cava vein could be found, confirming the diagnosis of ACF (Figure 1A). Angulated aneurysm and tortuous aorto-iliac access were also shown (Figure 1B). Preoperative accurate measurements showed that the aneurysm neck angle is 44.4 degrees, the neck length is 52 mm, the proximal neck diameter is 25.5 mm, the distal neck diameter is 24.8 mm, the diameter of the left common iliac artery is 20.5 mm, the diameter of the right common iliac artery is 26.4 mm, the diameter of the left internal iliac artery is approximately 32 mm, and the diameter of the right internal iliac artery is approximately 34 mm (Figure 1C).
case_images: (A) The angiogram confirmed the large AAA with ACF. (B) After standard EVAR, intraoperative angiography showed the type Ia endoleak. (C) There was no endoleak after implanting an Excluder aortic stent-graft cuff.
case_images: fcvm-12-1518025-g002.jpg
case_images: PMC11821926_01_fcvm-12-1518025-g002.jpg
case_images: F2
case_images: Initial angiography (contrast agent total 25 ml, 20 ml/sec, pressure 60 mmHg) revealed the formation of AAA and the diagnosis of ACF (Figure 2A). After standard EVAR, however, repeat angiography showed persistent type Ia endoleak (Figure 2B). Associates, Flagstaff, AZ) (Figure 2C). At this time, the central venous pressure dropped to 10 mmHg.
case_images: (A) Postoperative CTA showed no evidence of the fistula or the endoleaks. (B,C) At the 9-month follow-up, CTA showed no evidence of endoleak or fistula.
case_images: fcvm-12-1518025-g003.jpg
case_images: PMC11821926_01_fcvm-12-1518025-g003.jpg
case_images: F3
case_images: The post-operative CTA revealed the disappearance of leakage from the abdominal aorta to the inferior vena cava and no evidence of the endoleak (Figure 3A). CTA at the 9-month postoperative follow-up showed that the ACF had permanently vanished, with no endoleak observed (Figures 3B,C).