Multistage Endovascular Management of an Aortic Aneurysm Rupture into the Retroaortic Left Renal Vein.

Aortic aneurysm rupture into the retroaortic left renal vein (RALRV) is an uncommon phenomenon. We herein present the case of a 66-year-old man with left flank pain, hematuria, fever, and symptoms of acute right-sided heart failure. Computed tomography angiography (CTA) demonstrated an 83-mm infrarenal aortic aneurysm with a fistula in between the aorta and the RALRV. The patient underwent an urgent endovascular aneurysm repair and a proximal cuff extension due to type Ia endoleak. In the early postoperative period, transcaval coil embolization was performed, 3 months later repeated CTA revealed recanalized fistula, after fluid embolization and vascular plug implantation control CTA showed no sign of endoleak. The patient recovered uneventfully, 1-year follow-up CTA demonstrated aneurysm shrinkage and no sign of endoleak.