Emergency Endovascular Aneurysm Repair Coupled with Staged Omentopexy for Primary Aorto-Duodenal Fistula

Abstract

A primary aorto-duodenal fistula (ADF), a rare, spontaneous development of a communication between the aorta and duodenum, is a disastrous complication of an abdominal aortic aneurysm. A 73-year-old patient with primary ADF underwent emergent endovascular aneurysm repair (EVAR), followed by staged omentopexy, without removing a stent graft (SG). The patient received long-term treatment with antibiotics, and there has been no evidence of infection during a follow-up period of three years. Emergency EVAR coupled with omentopexy, may be a treatment option for primary ADF, even when it means leaving the SG in a potentially infectious site.

Primary aortoduodenal fistula: As a first presentation of brucellosis; a case report

“…PAEFs establish a direct communication between the native aorta and any part of the GI system. Its prevalence is estimated to range from 0.04 % to 0.07 % [ 5 ].According to published research, PAEFshave an 80–100 % total fatality rate without surgical intervention. Although the exact cause of PAEF formation remains unknown, atherosclerotic AAA is identified in 83 % of cases, suggesting that repetitive mechanical stress induced by the pulsation of the aneurysm may be a hallmark of PAEF development [ 5 , 10 ].…”

“…Due to its uncommon clinical presentation, diagnosing and treating primary AEF can be challenging, despite advancements in imaging and endoscopic technologies. Symptoms may include hemodynamic instability and significant gastrointestinal bleeding, presenting as hematemesis, melena, rectorrhagia, or a combination of these manifestations [ 4 , 5 ].…”

Aortoduodenal fistula after repair of a stab injury to the abdominal aorta

“…These have included the following: (1) excision of the aortic graft, oversewing of the abdominal aortic stump, axillobifemoral bypass, duodenal repair or resection/anastomosis; (2) excision of the aortic graft, insertion of an in situ antibiotic-impregnated new graft, duodenal repair; (3) injection of a sealant into the fistula, insertion of an endovascular stent graft as a temporizing maneuver in critically ill patients, later replacement of the stent graft and abdominal aorta; and (4) insertion of an endovascular stent graft, lifelong antibiotic therapy in a patient with severe medical comorbidities and a projected limited lifespan. [4][5][6][7][8][9][10][11][12][13]…”

Case report: Remedial surgical treatment of aorto-duodenal fistula with infected aneurysm after endovascular aortic repair

“…Aorto-duodenal fistula management goals include maintaining distal perfusion after controlling the hemorrhage and preventing recurrent infection ( 6 ). Once ADF is diagnosed, preventive measures, such as antibiotic therapy, delicate surgery for eradication of septic focus with thorough debridement of infected and devitalized tissue, and reconstruction of the excised aorta by extra-anatomic or an in situ route, are required ( 7 , 8 ).…”