Endovascular Repair for Aorto-enteric Fistula: A Bridge Too Far or a Bridge to Surgery?

Danneels, Maya; Verhagen, Hence J.M.; Teijink, Joep A.W.; Cuypers, Ph.; Nevelsteen, André; Vermassen, Frank

doi:10.1016/j.ejvs.2005.11.031

Cited by 90 publications

(68 citation statements)

References 17 publications

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“…Within 12 months, over half of the patients who survived the initial surgery showed signs of reinfection and required reoperation despite ongoing antibiotic treatment [ 33 ]. These results reinforce the principle that endovascular therapy for AEF should be viewed as a temporizing measure to stop exsanguination and allow preparation for defi nitive graft excision.…”

Section: Discussionsupporting

confidence: 60%

Surgical and Endovascular Complications: Infection and Hemorrhage

Davies

2014

Essentials of Vascular Surgery for the General Surgeon

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In all cases of hemorrhage, the Advanced Trauma Life Support (ATLS) algorithm should be followed, with prompt recognition, rapid resuscitation, and immediate decision making and action [ 1 ]. Retroperitoneal Hemorrhage EtiologyRetroperitoneal hematoma (RPH) describes bleeding into the potential space between the peritoneum and the musculoskeletal elements of the back. Several conditions can cause RPH including ruptured aortic aneurysm, traumatic vascular injury, retroperitoneal neoplasms, and coagulopathy. RPH occurs most frequently as a complication of percutaneous femoral artery puncture for interventional procedures. The reported incidence of RPH after cardiac catheterization is 0.15 % for diagnostic procedures, 0.8 % for balloon angioplasty, and 3 % for coronary stents. Three dichotomous variables were identifi ed as independent predictors of RPH: female gender (odds ratio [OR] 5.4), body surface area (BSA) less than 1.73 m 2 (OR 7.1), and high femoral artery puncture site (OR 5.3) [ 2 ]. Twenty-fi ve percent of retroperitoneal bleeds were remote from the femoral artery puncture site, with the majority of these being contralateral to the side of the puncture. PresentationThe diagnosis of retroperitoneal hematoma requires clinical acumen, and an awareness of the scenarios in which this complication is likely to occur. Patients with signifi cant groin, fl ank, abdominal, or back pain or hemodynamic instability following an interventional procedure should be evaluated for a retroperitoneal hematoma. The nonspecifi c symptoms associated with RPH often delay the diagnosis. Approximately 23-54 % of retroperitoneal hematoma patients have documented clinical evidence of femoral neuropathy caused by compression of the femoral nerve [ 3 ]. Seventy-fi ve percent of cases presented within the fi rst 3 h after conclusion of the procedure, with a rapid decline in frequency after this time period [ 4 ]. Spontaneous hemorrhage usually occurs in patients receiving anticoagulation. Idiopathic retroperitoneal hematoma may present symptomatically in the form of acute abdominal pain, nausea, and anorexia. Upon physical examination, the patient may have a tender abdomen and hypovolemic shock. ImagingContrast-enhanced computed tomography (CT) scan is the imaging modality of choice to identify and categorize a retroperitoneal hemorrhage (Fig. 23.1 ). TreatmentAlthough a widely accepted consensus on the management of patients with RPH does not exist, a reasonable treatment algorithm is shown in Fig. 23.2 . Conservative TherapyHemodynamically stable patients with RPH can be managed with fl uid resuscitation, correction of coagulopathy, and blood transfusion. Non-interventional therapy mandates close observation for the development of abdominal compartment syndrome (ACS) which can be fatal if it is not promptly recognized and treated. ACS is defi ned as sustained intra-abdominal pressure greater than 20 mmHg with end-organ dysfunction manifested as respiratory insuffi ciency, oliguria, and decreased venous return resulting in severe hy...

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Section: Discussionsupporting

confidence: 60%

Surgical and Endovascular Complications: Infection and Hemorrhage

Davies

2014

Essentials of Vascular Surgery for the General Surgeon

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“…Artificial graft infections, which are mainly associated with polyester grafts, often lead to fatal complications such as the formation of an aortoenteric fistula or pseudoaneurysm. [17][18][19][20] To manage these complications, homograft replacement with an omentum flap can be applied; however, despite a great amount of effort being expended, the outcomes are often not satisfactory. 17 In addition, the number of potential homografts is limited, and suitable replacements are not always available from tissue banks.…”

Section: Discussionmentioning

confidence: 99%

“…The palliative covering of fistulas with ready-made endovascular stent grafts has also been reported although the frequency of recurrent infections among such cases is extremely high. 17,18 Thus, the Bio stent graft, which is covered by connective tissue, may be useful for the primary management of graft infections or aortoenteric fistulas.…”

Section: Discussionmentioning

confidence: 99%

Development of tissue‐engineered self‐expandable aortic stent grafts (Bio stent grafts) using in‐body tissue architecture technology in beagles

et al. 2014

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In this study, we aimed to describe the development of tissue-engineered self-expandable aortic stent grafts (Bio stent graft) using in-body tissue architecture technology in beagles and to determine its mechanical and histological properties. The preparation mold was assembled by insertion of an acryl rod (outer diameter, 8.6 mm; length, 40 mm) into a self-expanding nitinol stent (internal diameter, 9.0 mm; length, 35 mm). The molds (n = 6) were embedded into the subcutaneous pouches of three beagles for 4 weeks. After harvesting and removing each rod, the excessive fragile tissue connected around the molds was trimmed, and thus tubular autologous connective tissues with the stent were obtained for use as Bio stent grafts (outer diameter, approximately 9.3 mm in all molds). The stent strut was completely surrounded by the dense collagenous membrane (thickness, ∼150 µm). The Bio stent graft luminal surface was extremely flat and smooth. The graft wall of the Bio stent graft possessed an elastic modulus that was almost two times higher than that of the native beagle abdominal aorta. This Bio stent graft is expected to exhibit excellent biocompatibility after being implanted in the aorta, which may reduce the risk of type 1 endoleaks or migration.

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“…The advent of percutaneous endovascular techniques revolutionized the management of AEF, especially for patients unsuitable for open surgery. Danneels et al(2006) reviewed 15 cases between 1999 and 2005 and concluded that endovascular sealing of AEF provides time to treat shock, local and systemic infection, and comorbidity, which creates a better situation to perform future open repair, with possibly better outcome.…”

Section: Discussionmentioning

confidence: 99%

Aortoduodenal fistula following aortic reconstruction of a pseudoaneurysm caused by stab wound 12 years ago

Zhou

Shen

et al. 2009

J. Zhejiang Univ. Sci. B

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Abstract:Gastrointestinal bleeding due to aortoenteric fistula is extremely rare. Aortoenteric fistula is difficult to be diagnosed timely and entails a significant morbidity and mortality. Herein, we present an uncommon case of gastrointestinal bleeding caused by aortoduodenal fistula, which was a complication of a successful aortic reconstruction 4 months ago for an aortic pseudoaneurysm resulted from a stab wound 12 years ago. An urgent laparotomy confirmed an aortoduodenal fistula and repaired the defects in aorta and duodenum, but a prolonged shock led to the patient's death. In summary, early diagnosis and surgical intervention for aortoenteric fistula are vital for survival.

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Endovascular Repair for Aorto-enteric Fistula: A Bridge Too Far or a Bridge to Surgery?

Cited by 90 publications

References 17 publications

Surgical and Endovascular Complications: Infection and Hemorrhage

Surgical and Endovascular Complications: Infection and Hemorrhage

Development of tissue‐engineered self‐expandable aortic stent grafts (Bio stent grafts) using in‐body tissue architecture technology in beagles

Aortoduodenal fistula following aortic reconstruction of a pseudoaneurysm caused by stab wound 12 years ago

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