Aorto-left renal vein fistula: Is there a place for endovascular management?

Purpose: To describe the endovascular treatment of an aorto-left renal vein fistula. Methods and Results: A 77-year-old man with multiple comorbidities presente d with low back pain, hematuria, cyanosis, and a pulsatile abdominal mass. Imaging confirmed a 7-cm abdominal aortic aneurysm with a contained rupture into the left ren a I vein. Owing to the patient's high surgical risk, a T alent Endoluminal Stent-Graft was implanted to satisfactorily exclude the a neurysm. Hemodynamic stability and normal renal function were restored; how ever, continued perfusion of the sec prompted an attempt to percutaneously repair the renal vein defect. This effort failed, so open laparotomy was ne cessary. Conclusions: Although total endovascular management was not successful in t his case, the initial use of a minimally invasive approach allowed the pati ent's clinical status to improve and lower the risk of subsequent surgery.