Persistent endoleak after endovascular exclusion of an aortocaval fistula, producing renal insufficiency

This report presents a case of type II endoleak after endovascular exclusion of a primary aortocaval fistula, producing renal vein hypertension and renal insufficiency. A 74-year-old patient presented with acute renal insufficiency, hematuria, lower limb edema, and weight gain. The abdominal CT scan revealed an abdominal aortic aneurysm and an aortocaval fistula. An endograft was deployed but type II endoleak was present and persisted after surgical ligation of the inferior mesenteric artery and subsequent unsuccessful attempt of coil-embolization. The patients renal function continued to be impaired. Surgical ligation of aortocaval communication with preservation of the endograft was performed, resulting in restored renal function.