Extremities are one of the favorite sites of AVM. Intravascular treatment of the area plays an important role because it is easy relatively to approach the nidus by trans-arterial or trans-venous route and percutaneous puncture. It is necessary to prevent flowing-out of sclerosant agents to proximal normal veins and to remain sclerosant agent into the target vascular as long as possible when sclerotherapy is performed. Certain flow control can be performed in lesions of extremities. Selection of the best treatment for each patient according to precise evaluation of anatomy and flow-model of lesions is important for achievement of the treatment outcome and prevention of complications.
A 75-year-old man consulted our hospital because of anorexia. Liver and renal dysfunctions were found in a laboratory examination and plain CT revealed Abdominal Aortic Aneurysm. Although hemodialysis was done after admission, the improvement of renal function was poor. Because enhanced CT revealed aortocaval fistula, we were consulted for purpose of surgery immediately. We performed fistula closure and Y-graft replacement of the abdominal aorta. After the operation, the renal dysfunction was immediately improved. Aortocaval fistula is rare but should be considered if patients have symptoms of right heart failure or liver and renal dysfunctions complicated with Abdominal Aortic Aneurysm.