The formation of an aortocaval fistula following endovascular repair of a ruptured abdominal aortic aneurysm (AAA) is a rare and potentially fatal complication. This case study describes the successful closure of a persistent aortocaval fistula following rEVAR using the Amplatzer Septal Occluder (Abbott) in a 75 year old male presenting with a ruptured AAA with fistula into the IVC.

Aortocaval fistulae have traditionally been repaired with surgery which has a mortality rate as high as 30%.The first successful endovascular repair was described by Beveridge et al. In the literature there are only 3 cases that have reported the successful closure of a persistent aortocaval fistula following rEVAR using a amplatzer septal occluder. The similar anatomy between an ASD and the neck of an aortocaval fistula gives the amplatzer septal occluder several advantages.

A 75 year old male ex-smoker presented to hospital with a sudden onset of abdominal pain and heart failure. CT angiogram demonstrated a ruptured 12 cm abdominal aortic aneurysm with fistula into the IVC. He underwent an emergency EVAR. Five months later he returned for an endovascular aortic cuff and endoanchors. Day one post operative ultrasound demonstrated a type 2 endoleak from the left posterior aspect of the residual aneurysm sac, likely from the left lumbar artery. Repeat ultrasound six weeks later demonstrated two areas of endoleak in the aortic aneurysm sac. Subsequently he returned with abdominal and back pain seven months later. CT angiogram demonstrated an aortocaval fistula. A 7 mm amplatzer septal occluder was used to successfully close the aortocaval fistula.

There is a lack of case studies reporting endovascular strategies for secondary closure of persistent ACFs. Concomitant type II endoleaks may need treatment for complete resolution. A long term surveillance imaging programme is vital to characterise the durability of repair and monitor for potential rare complications.