Fistula between the abdominal aorta and a retroaortic left renal vein: a rare complication of abdominal aortic aneurysm

摘要

A 63-year-old man was referred to our hospital with ab- dominal pain, left varicocele, hematuria, and acute kidney in- jury. Multislice computed tomography (CT) revealed a 7.8 cm infrarenal abdominal aortic aneurysm and no contrast enhance- ment of the left kidney (Figure 1A), as well as a retroaortic left renal vein and dilatation of the left gonadic vein (Figure 1B), together with simultaneous contrast enhancement of the an- eurysm, inferior vena cava, and left renal vein, suggesting the presence of a fistula between the abdominal aortic aneurysm and the aberrant left renal vein (Figures 1C and 1D). Given the suitability of the aneurysm, we decided to perform endovascular repair. Exclusion of the aneurysm and the aorto-left renal vein fistula was achieved after successful deployment of a 26a??14 ?? 165 mm bifurcated endoprosthesis with a 16a??16 ?? 95 contralat- eral limb (Gore Excluder; W.L. Gore and Associates, Flagstaff, AZ, USA). After endovascular management, renal function ini- tially improved. The patient presented intraoperative hypoten- sion, and the postoperative course was complicated by brain ischemia. Unfortunately, the patient died 65 days after surgery due to multiorgan failure.