Endograft Infection Due to Secondary Aortoenteric Fistula Treated With Custom-Made Bovine In Situ Aortic Bifurcation Graft

Walter, C.; Taher, Fadi; Rieger, Hannes; Assadian, Afshin; Falkensammer, Juergen

doi:10.1177/1538574418805868

Cited by 4 publications

(4 citation statements)

References 16 publications

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“…Surgical repair of AEF is potentially highrisk due to fear of massive bleeding and sepsis, with a mortality rate of 37%. 6,11 Suprarenal aortic clamping is frequently required for complete removal of all stent graft components. 2,6 Classically, extra-anatomic reconstruction that involved an axillobifemoral bypass, followed by endograft explantation and aortic ligation, was the standard approach for treating patients with infected aortic prostheses.…”

Section: Discussionmentioning

confidence: 99%

Aortoduodenal Fistula After Endovascular Aortic Repair for an Inflammatory Abdominal Aortic Aneurysm: A Case Report

Moriyama

Kimura

Takago

et al. 2020

Vasc Endovascular Surg

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Aortoenteric fistula after endovascular aortic repair for an abdominal aortic aneurysm is a rare but severe complication. Particularly, a case of inflammatory abdominal aortic aneurysm is extremely rare and there are only 3 reported cases. A 70-year-old man underwent endovascular aortic repair for impending rupture of an inflammatory abdominal aortic aneurysm and was medicated steroids for approximately 2 years. Four years after endovascular aortic repair, he developed endograft infection with an aortoduodenal fistula and a left psoas abscess. He underwent total endograft excision, debridement, in situ reconstruction of the aorta using prosthetic grafts with omental coverage, and digestive tract reconstruction to prevent leakage. Pseudomonas aeruginosa was detected in the infected aortic sac. The patient has not experienced recurrence of infection in the 35 months since his operation.

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Section: Discussionmentioning

confidence: 99%

Aortoduodenal Fistula After Endovascular Aortic Repair for an Inflammatory Abdominal Aortic Aneurysm: A Case Report

Moriyama

Kimura

Takago

et al. 2020

Vasc Endovascular Surg

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“…17 Several alternative operative approaches have been suggested, most notably in situ replacement of the aortic prosthesis with antibiotic-soaked prosthetic or a tissue conduit such as autogenous superficial femoral vein or cryopreserved aortic homograft. 1,18,19 This latter approach appears to yield improved outcomes and, when technically feasible, has become the treatment-of-choice. 3,20 Secondary aortoenteric fistula formation in the endovascular era appears to be less common, likely because the excluded aneurysm sac provides a natural anatomic barrier separating the aortic prosthesis from the duodenum.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Post-Evar Aortoduodenal Fistula Without Endograft Excision

Joshi

Ogbudinkpa

Stecher

et al. 2020

Vasc Endovascular Surg

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An 80 year-old gentleman presented with aortoduodenal fistula 2 months after uncomplicated endovascular aneurysm repair (EVAR). Upon laparotomy and fistula takedown, there was no active hemorrhage from the excluded aneurysm. It was theorized the fistula had originated from an occult type II endoleak which had since thrombosed. The duodenum was repaired primarily; the anterior defect in the aneurysm sac was packed and covered with omentum. The patient recovered uneventfully and remains well after 9 months. This is the first case, to our knowledge, of a post-EVAR aortoduodenal fistula successfully treated without endograft excision.

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“…Review of the literature yielded 24 previous studies, conducted between 1998 and 2018, which dealt with 32 patients with secondary AEF after EVAR 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24. Characteristics and peri-operative data obtained from case reports are shown in Table 1.…”

Section: Discussionmentioning

confidence: 99%

Secondary Aorto-enteric Fistula and Type II Endoleak Five Years after Endovascular Abdominal Aortic Aneurysm Repair

Koda

Murakami

Yoshida

et al. 2019

EJVES Short Reports

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Introduction Secondary aorto-enteric fistula (AEF) after endovascular abdominal aortic aneurysm repair (EVAR) is a rare but potentially fatal disease. The aetiology and mechanisms are unclear. This study presents a patient who developed secondary AEF and type II endoleak five years after EVAR. Case A 73 year old man underwent successful EVAR with a bifurcated aortic stent graft for a 5.5 cm infrarenal abdominal aortic aneurysm. The aneurysm sac showed no change in size for three years, then shrank 20 mm to 3.5 cm by five years. After five years and eight months, the patient presented with fever and back pain. Enhanced CT demonstrated enlargement of the aneurysm sac, type II endoleak from the third and fourth right lumbar arteries, and air around the stent graft. An emergency operation was performed. The infected stent graft was removed by pushing up the stent graft to release the hooks from the wall of the aorta. A small fistula resembling a fish mouth measuring 1×1 cm was observed in the third part of the duodenum. The fistula was closed by direct suture, and in situ reconstruction was performed with an 18×9 mm standard polyethylene terephthalate graft. Culture of the explanted stent graft grew enterobacter. Intravenous antibiotic therapy was continued for six weeks and was stopped after confirming no recurrence of infection with computed tomography and laboratory testing. Two years later, there has been no recurrence of infection. Conclusion Long term surveillance is critical because AEF can occur even after initially successful EVAR.

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Endograft Infection Due to Secondary Aortoenteric Fistula Treated With Custom-Made Bovine In Situ Aortic Bifurcation Graft

Cited by 4 publications

References 16 publications

Aortoduodenal Fistula After Endovascular Aortic Repair for an Inflammatory Abdominal Aortic Aneurysm: A Case Report

Aortoduodenal Fistula After Endovascular Aortic Repair for an Inflammatory Abdominal Aortic Aneurysm: A Case Report

Treatment of Post-Evar Aortoduodenal Fistula Without Endograft Excision

Secondary Aorto-enteric Fistula and Type II Endoleak Five Years after Endovascular Abdominal Aortic Aneurysm Repair

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