PMC5573105_01
CXR revealing cardiomegaly and pulmonary redistribution consistent with pulmonary edema.
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CT angiogram demonstrating dilated IVC and pelvic vasculature as well as a communication between the left common iliac artery and vein.
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Intra-operative fluoroscopic view demonstrating the proximal end of the stent graft oriented at the lateral wall of the common iliac artery.
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AV fistula was covered but the opening of the proximal graft was essentially facing the sidewall (Fig. 3). An additional Medtronic Endurant iliac stent (ENLW 2424C80) was delivered to the aortic bifurcation and was easily deployed properly because at this point the flow through the fistula had been effectively blocked by the first stent, thus decreasing the flow rates.
Final intra-operative angiogram demonstrating the two overlapping stents. Note the stenotic area (12 mm) at the junction of the proximal and middle third of the grafts, which was inconsequential clinically and on follow-up lower limb flow studies.
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No balloon angioplasty was attempted for fear of perforating the iliac sidewall (Fig. 4).
3D reconstruction of arterial phase, 1-month post stent graft insertion. No AV fistula seen, mild stent stenosis.
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Post-operative CT scan showed no residual fistula and mild stenosis of the iliac stent (Fig. 5).