Endovascular Treatment of a Primary Aortoduodenal Fistula: 2-Year Follow-Up of a Case Report

Abstract

The purpose is to evaluate the role of endovascular management for primary aortoduodenal fistula in poor surgical risk patients. A 70-year-old-man was admitted at the emergency room of our hospital with recurrent upper-gastrointestinal bleeding. A diagnostic workup was suggestive of a primary aortoduodenal fistula caused by erosion of an infrarenal abdominal aortic aneurysm. Intractable cardiac arrhythmia, recurrent hemorrhage, and poor patient condition were compatible with an exceedingly high surgical risk. The fistula was successfully treated, and gastrointestinal bleeding was eliminated with placement of a Lifepath endoluminal aortoiliac stent graft. At the 21-month follow-up, the patient was not presenting with symptoms and signs of graft infection, and radiologic studies confirmed decreasing aneurysm size without associated signs of local sepsis. Endovascular stent grafts can efficiently arrest massive exsanguination in critically ill patients with primary aortoenteric fistula. The risk of graft infection remains the most serious problem associated with this approach.

What to Do When Evidence is Lacking — Implications on Treatment of Aortic Ulcers, Pseudoaneurysms and Aorto-Enteric Fistulae

“…Anumber of case series of open reconstructions (29,30,39) exists but morerecent case reports on endovascular treatment add to our present treatment strategy for these patients. Reports have discussed using endovascular technique for primary repair or as ab ridge for later open surgery (42,43). Thelargest endovascular experienceso far is reported by Mount Sinai Hospital and Mike Marin's group who recently described the outcome among 16 patients of whom seven weretreated with open surgery and nine with endovascular technique (44).…”

Hybrid repair of ruptured infected anastomotic femoral pseudoaneurysms: Emergent stent-graft implantation and secondary surgical debridement

“…Indeed, placing an endoprosthesis in an infected field is debatable, despite the reports of successful use of stent-grafts in infected tissues as in the case of infected true and false aneurysms, [16][17][18][19] or in patients with aorto-duodenal fistulas. 20,21 Principles of standard management dictate that deployment of a covered stent would be unlikely to succeed as a treatment option for infected pseudoaneurysms, since exclusion rather than excision of the pathology may lead to closed-spaced infection and contamination of the newly placed device with possible limb and life-threatening consequences. 6 To avoid such devastating complications, a second operation consisted of surgical excision of the infected pseudoaneurysm and surrounding tissues and selective sartorius muscle flap coverage of the CFA was performed 1-3 days after stent-graft placement.…”

Haematemesis due to primary aortic aneurysm-duodenal fistula - clinical suspicion is the cornerstone of diagnosis: a case report

“…More recently, in situ grafting using autogenous vein, either superficial femoral vein [11] or spiraled saphenous vein [12] has been recommended. Finally, successful endovascular stent grafting has been reported in the case of a very high risk patient giving us an additional option for the future [13]. …”