Objective: Rupture of abdominal aortic aneurysms (AAA) into the iliac or caval veins through arteriovenous fistulas (AVFs) is a rare but life-threatening complication. We report a case of a 74-year-old man with complex aorto-iliac aneurysmal disease and a spontaneous right iliac AVF, presenting with worsening dyspnea and signs of congestive heart failure. Case presentation: A 74-year-old man with complex aorto-iliac aneurysmal disease and a spontaneous right iliac AVF, presented with worsening dyspnea and signs of congestive heart failure. Imaging revealed a 45 mm infrarenal AAA, a 50 mm right common iliac artery aneurysm, and an 87 mm right external iliac artery aneurysm. The anatomical configuration—including a short, angulated proximal neck and severely tortuous iliac arteries—rendered the patient unsuitable for endovascular repair. Therefore, an emergent open surgical repair was performed, consisting of aneurysmectomy, AVF closure, and aorto-bi-iliac reconstruction using a Dacron graft. Postoperative recovery was uneventful, with improvement in cardiac and renal function. Conclusion: This case highlights the ongoing relevance of open surgical approaches in an era dominated by endovascular techniques, particularly when anatomical or hemodynamic challenges limit the feasibility of minimally invasive options.
Oddi et al. (Fri,) studied this question.