AORTOCAVAL FISTULAS - A PERCUTANEOUS MODEL AND TREATMENT WITH STENT GRAFTS IN SHEEP

Background Treatment of aortocaval fistulae (ACFs) by open surgery is known to be a high-risk procedure. In this experimental study, we deve loped a percutaneous model of ACF to test a new nonsurgical method of treatment of ACF using endo vascular stent grafts. Methods and Results An ACF was treated percutaneously in eight sheep. Via a combined Veno us and arterial femoral approach, angioplasty balloons were inserted t o occlude the infrarenal aorta and inferior vena cava (IVC). The IVC w as punctured through the lateral aortic wall with a transjugular liver biopsy needle. The fistulous tract was then dilated with an 8-mm angi oplasty balloon, and the animal was heparinized. Two weeks later, a 10 -mm Cragg-Endopro-Stent was inserted into the aorta at the level of th e fistula via a percutaneous femoral approach. ACFs were successfully created in all animals, with rapid dye shunt through the fistula and a 20% increase in cardiac pulsations. Follow-up angiograms at 2 weeks s howed a patent ACF, and stent implantation excluded the fistula in eve ry case. Angiographic and pathological examinations up to 6 months dem onstrated normal aortic patency and persistent exclusion of the fistul ae. Conclusions ACFs were effectively treated by endovascular grafting of the aorta. The animal model and the stenting procedures were both performed percutaneously.