Aortoduodenal fistula and associated rupture of abdominal aortic aneurysm after endoluminal stent graft repair

Abstract

The main complications of endovascular repair of abdominal aortic aneurysms are vascular leaks and rupture, although infection and aortoduodenal fistulas have also been reported rarely. We report a case of aortoduodenal fistula with separate retroperitoneal rupture of an abdominal aortic aneurysm after endovascular stent graft repair. The initial implantation was uneventful, without any leaks at 1 month. The patient underwent open repair and did well. To our knowledge, this is the first case report of aortoduodenal fistula and associated retroperitoneal rupture of the aneurysm after endovascular stent graft repair of an abdominal aortic aneurysm.

Aortoduodenal Fistulas After Endovascular Stent-Graft Repair of Abdominal Aortic Aneurysms:Single-Center Experience and Review of the Literature

“…It has been suggested that this condition may result in pressure necrosis of the aneurysm against the intestinal wall. 11,21,[41][42][43][44] Two of the patients in our report had a postoperative endoleak that may have been a cause for endotension, leading, at least partially, to erosion of the duodenal wall.…”

AAA Stent–Grafts: Past Problems and Future Prospects

“…2,4,12,64,90,116 However, EVAR patients are not immune to the development of ADF and a small number of cases have been reported in the literature. 2,4,12,42,49,51,83,90,96,105,111,116 The exact cause for the development of ADF following EVAR remains unclear. A strong hypothesis is that local infection, which could be secondary to the grafting procedure or pre-existent (EVAR done for mycotic aneurysms) could result in intestinal necrosis and the formation of a fistula between the aneurysm and the intestinal wall.…”

“…96 Endotension may also lead to the formation of ADF, resulting from pressure necrosis of the aneurysm against the intestinal wall. 2 Bertges et al 12 also suggested that extensive sac embolization after EVAR may eventually lead to an ADF; therefore, it may be wise to limit the embolization sessions and the number of coils inserted into the sac to treat an endoleak.…”

Conversion to Open Repair After Endografting for Abdominal Aortic Aneurysm: A Review of Causes, Incidence, Results, and Surgical Techniques of Reconstruction

“…37,[39][40][41][42][43][44][45][46] Endoleak and even endotension may also lead to aortoenteric fistula formation, ostensibly due to pressure necrosis from the aneurysm sac against the intestinal wall. [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] The rate of aortoenteric fistula formation is difficult to determine. In a recent report from Saratzis et al, 46 there were 5 (1.8%) cases among 270 EVAR procedures.…”