Objective: To demonstrate the treatment of an unusual aorto-caval shunt by embolization and implantation of a covered stent to the IVC. Material and method: Male, 56 years. In 1992 during lumbar spine disc surgery the abdominal aorta was inadvertently injured and an aorto-caval shunt finally developed with developing symptoms of LV failure. Final surgical treatment was an aortobiiliac bypass with ligation of the aorta and both common iliac arteries, but on FU i.v. DSA an early filling of IVC was detected. During the first years after the surgery the patient was doing well, but in 1998 the symptoms of LV failure reoccurred (dyspnoea, LV enlargement, Cl=4.0 l/min/m 2 ). Angiography detected a significant A-V shunt arising from an excluded aortic segment that was filled by retrograde flow from lumbar arteries. By a retrograde approach via IVC a catheter was introduced through the shunt channel to the excluded aorta and 4 pieces of 30 cm embolization coils were introduced. A custom made Ella covered stent was implanted into the IVC to seal the shunt channel. The patient is symptoms free, LV diminished in size, Cl dropped to 2.7 l/min/m 2 . Radionuclide study did not detect any shunt to IVC, FU angiography revealed a minor, almost non-detectable A-V shunt to IVC.

        Key words: embolization – aorto-caval shunt – covered stent