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Int J Angiol 2015; 24(01): 55-58
DOI: 10.1055/s-0033-1349714
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Endovascular Management of Secondary Aortoduodenal Fistula: The Importance of Gut Restoration

Konstantinos G. Moulakakis
1   Department of Vascular Surgery, Athens University Medical School, “Attikon” University Hospital, Athens, Greece
,
John Kakisis
1   Department of Vascular Surgery, Athens University Medical School, “Attikon” University Hospital, Athens, Greece
,
Ilias Dalainas
1   Department of Vascular Surgery, Athens University Medical School, “Attikon” University Hospital, Athens, Greece
,
Vasilis Smyrniotis
2   4th Department of Surgery, Athens University, Medical School, “Attikon” University Hospital, Athens, Greece
,
Christos D. Liapis
1   Department of Vascular Surgery, Athens University Medical School, “Attikon” University Hospital, Athens, Greece
› Author Affiliations
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Publication History

Publication Date:
17 February 2014 (online)

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Abstract

Secondary aortoenteric fistula (SAEF) is a rare, life-threatening complication of aortic reconstructive surgery. Graft excision associated with gut repair and extra-anatomic bypass or in situ aortic reconstruction is the best option. However, it is associated with high mortality rates, especially when undertaken in unstable patients with severe comorbidities. We present a case of SAEF successfully treated by endovascular repair and gut restoration. After laparotomy, a dense inflammatory “frozen” mass was found around the involved part of the duodenum and the aortic sac. Because of his comorbidities, the difficulty in dissection of the aortic sac and the risk of damage in adjacent organs, the initial plan for aortic reconstruction was abandoned. A surgical isolation of the third portion of the duodenum and a duodenum–jejunal anastomosis were performed. An Endurant endograft 32–16–16 mm (Medtronic, Inc., Minneapolis, MN) was implanted to achieve aortic continuity. Twenty months postdischarge, the patient remains in good general condition, afebrile, and with normal laboratory tests and inflammation markers. In high-risk patients, endovascular intervention combined with gut repair without further aortic reconstruction can be a permanent solution requiring, however, close surveillance.

Keywords

secondary - aortoenteric fistula - endovascular - gut repair
 

  • References

  • 1 Brock RC. Aortic homografting; a report of six successful cases. Guys Hosp Rep 1953; 102 (3) 204-228
    PubMedGoogle Scholar
  • 2 Antoniou GA, Koutsias S, Antoniou SA, Georgiakakis A, Lazarides MK, Giannoukas AD. Outcome after endovascular stent graft repair of aortoenteric fistula: A systematic review. J Vasc Surg 2009; 49 (3) 782-789
    CrossrefPubMedGoogle Scholar
  • 3 Szilagyi DE. Management of complications after arterial reconstruction. Surg Clin North Am 1979; 59 (4) 659-668
    PubMedGoogle Scholar
  • 4 Bergqvist D, Björck M. Secondary arterioenteric fistulation—a systematic literature analysis. Eur J Vasc Endovasc Surg 2009; 37 (1) 31-42
    CrossrefPubMedGoogle Scholar
  • 5 Batt M, Jean-Baptiste E, O'Connor S , et al. Early and late results of contemporary management of 37 secondary aortoenteric fistulae. Eur J Vasc Endovasc Surg 2011; 41 (6) 748-757
    CrossrefPubMedGoogle Scholar
  • 6 Deshpande A, Lovelock M, Mossop P, Denton M, Vidovich J, Gurry J. Endovascular repair of an aortoenteric fistula in a high-risk patient. J Endovasc Surg 1999; 6 (4) 379-384
    CrossrefPubMedGoogle Scholar
  • 7 Kakkos SK, Antoniadis PN, Klonaris CN , et al. Open or endovascular repair of aortoenteric fistulas? A multicentre comparative study. Eur J Vasc Endovasc Surg 2011; 41 (5) 625-634
    CrossrefPubMedGoogle Scholar