Acutely Bleeding Aortoduodenal Fistula: Staged Endovascular and Open Surgical Repair

Abstract

Secondary aortoduodenal fistula is an uncommon but potentially fatal complication that can occur after aortic reconstruction surgery and usually presents with upper gastrointestinal hemorrhage. Taking into account the accompanying multiple comorbidities of those patients, conventional open surgical repair carries with it significant mortality and morbidity rates. The purpose of this case report is to describe the successful combined endovascular and open surgical repair of an acutely ruptured aortoduodenal fistula in a 67-year-old male patient. Four months after the procedure, the patient remains well.

Late outcome following open surgical management of secondary aortoenteric fistula

“…Endovascular treatment is currently regarded as a bridge procedure in patients who are hemodynamically unstable or high risk [30,31]. Recently, only few publication came out with the complex management [31,32], which means not only the stent-graft insertion, but couple of days or weeks later, the closure of the duodenum and removal and replacement of the infected grafts and stent graft. This second operation is expected to be a serious procedure with suprarenal clamping.…”

Intra-Aortic Balloon Occlusion (IABO) may be useful for the management of secondary aortoduodenal fistula (SADF): A case report

“…As seen in the present case, aortoenteric fistula (AEF) may result in a large amount of intestinal bleeding. Recent developments in interventional radiology have enabled us to plan a two-stage operation, with definitive surgery delayed until after temporary control of bleeding from the stent graft [2] , [9] , [10] , [11] . In our case, we were not able to perform endovascular aortic repair (EVAR), nor send him to another facility, due to his unstable condition.…”

Open or Endovascular Repair of Aortoenteric Fistulas? A Multicentre Comparative Study

“…Details of some patients in the EV-AEFR group have been partially provided in published case reports. 7,9,10 AEFs occurred after a median of 4 years after aortic surgery (endovascular aneurysm repair (EVAR) in four cases), while preoperative sepsis was evident in 19 cases (76%, with fever in 14, (56%)).…”