伴野 辰雄

Introduction: We report a case of aortocaval fistula successfully treated by hybrid operation. Case description: A 73-year-old female suffering from malignant lymphoma and painful leg edema was transferred to our institution. Computed tomography revealed an aortoiliac aneurysm. The inferior vena cava was compressed by displacement of the abdominal aortic aneurysm. The bilateral internal iliac and ovarian veins were markedly dilated. Diagnosis was an aortoiliac aneurysm with aortocaval fistula. The treatment options were open surgery or an intervention with bypass surgery. Because of narrow iliac access for a bifurcated stent graft, aorto-uni stentgraft treatment followed by bypass surgery was finally decided. Following stent graft insertion and iliofemoral artery bypass, the aneurysms and fistula were successfully excluded without endoleaks. To treat the inferior vena cava compression, the kissing technique was used to place bare metallic stents across the bilateral common iliac veins and inferior vena cava, which improved the clinical symptoms. Discussion and Evaluation: In this aortocaval fistula caused by AAA, a minimally invasive treatment of stentgraft and bypass surgery with venous flow recovery was chosen as a hybrid treatment. Intravascular intervention was the most suitable in this situation. Bare stent placement for venous occlusion was also effective for revascularization of vena cava flow. Conclusion: Recent advances in endovascular devices, including stent grafts and bare metallic stents, will be helpful for effective noninvasive treatment for aortocaval fistula circulation.

Purpose: The efficacy and safety of percutaneous transhepatic portal embolization (PTPE) with dehydrated ethanol was determined by measuring the liver lobe volume before and after the procedure. Materials and Methods: A total of 38 patients (25 men, 13 women mean age: 62.0 ± 10.8 years) who underwent PTPE with dehydrated ethanol between April 2005 and March 2011 participated in this study. Dehydrated ethanol containing 17% lipiodol was injected into the target portal vein branch under balloon occlusion, and the portal vein was subsequently embolized. The liver lobe volume was measured via contrast-enhanced computed tomography, and the percent increase in the unembolized lobe volume was then calculated. In addition, PTPE-related complications were surveyed, and the procedural safety was evaluated. Results: The mean percent increase in the unembolized lobe volume after PTPE was 33.8% ± 20.2%. The procedure could not be completed in one patient because of an insufficient increase in the unembolized lobe volume. No serious post- PTPE complications were observed. Conclusion: These data suggest that PTPE with dehydrated ethanol is a safe and effective method for enlarging the planned residual liver volume before extensive liver resection.