Aneurysm shrinkage is compatible with massive endoleak in the presence of an aortocaval fistula: Potential therapeutic implications for endoleaks and spinal cord ischemia

Research output: Contribution to journalArticle


Purpose: To present a patient with ruptured abdominal aortic aneurysm (AAA) and aortocaval fistula who was successfully treated with endovascular aneurysm repair in spite of developing a massive endoleak. Case Report: A 70-year-old man with ruptured AAA and aortocaval fistula was treated with endovascular aneurysm repair (EVAR). During 8 years of followup, he had massive perfusion of the aneurysm sac by retrograde flow from the inferior mesenteric artery into the caval vein through the aortocaval fistula. The aneurysm diameter decreased continuously in spite of the type II endoleak. This observation illustrates the mechanisms of sac expansion and may have therapeutic implications for complicated type II endoleaks and prevention of spinal cord ischemia in thoracic stent-grafting. Conclusion: EVAR can be applied in this rare setting because the ensuing high-flow endoleak is associated with sac shrinkage owing to depressurization by the caval shunt.


External organisations
  • Skåne University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems


  • Abdominal aortic aneurysm, Aortocaval fistula, Endoleak, Endovascular aneurysm repair, Ruptured aortic aneurysm, Spinal cord ischemia
Original languageEnglish
Pages (from-to)529-532
Number of pages4
JournalJournal of Endovascular Therapy
Issue number3
Publication statusPublished - 2016
Publication categoryResearch
Externally publishedYes