Intra-Aortic Balloon Occlusion (IABO) may be useful for the management of secondary aortoduodenal fistula (SADF): A case report

Abstract

HighlightsSecondary aortoduodenal fistula is one of life-threatening complication after surgical treatment for abdominal arterial aneurysm.The most important factor for acute management is controlling the bleeding from the fistula.Intra-aortic balloon occlusion may be one option for management of secondary aortoduodenal fistula.

Aortoduodenal fistula after abdominal aortic aneurism resection: Two case reports

“…Aortic occlusion over 45 min might cause irreversible dysfunction of organs and Compartment syndrome. [12] In our first case, aortic clamp were placed above aneurism with visceral artery, just beneath diaphragm. Visceral arteries were perfused with cold (+4C 0 ) Ringer lactate and ischemic time were prolonged.…”

“…First, pulsating movements of graft on the bowel, in cases where was no abscess or evidence of infection around fistula, chronic inflammation from mechanical pressure was possible cause of fistula. [12] Second reason is adhesion of infected graft to the bowel. Contribution to AEF is infection of the suture line of the anastomosis and bad cover with retroperitoneal tissue around graft.…”

“…It is easy to implement with immediate control of the bleeding from the aorta to duodenum. [12] But, if balloon were placed above visceral arteries, organ ischemia in short time and reperfusion will produce necrotic changes. Aortic occlusion over 45 min might cause irreversible dysfunction of organs and Compartment syndrome.…”

“…[4] Someone debrided scar tissue near the fistula or graft, then suture the defects of the aorta and the hole of duodenum as the less effective way. [12,7] AxFF were reserved for patients with periaortic purulence and an in situ aortic reconstruction used in cases with minor purulence. [1] Harvesting of saphenous vein should perform prior to clamping of aorta, except in cases of profuse bleeding where clamping has priority.…”

Secondary aortoduodenal fistula and the unrecognised herald bleed

“…When available, aortic occluders such as intra-aortic balloon occlusion or resuscitative endovascular balloon occlusion of the aorta are a recognised feasible strategy for fast temporary control of intra-abdominal bleeding or shock in patients with trauma. It is relatively easy to place and allows aortic bleeding control faster and easier than other techniques; its complications are organ ischaemia and reperfusion damage, recommending an intermittent deflection of the balloon and direct hand compression to allow limb blood flow 23. Once haemodynamic stability is achieved, vascular repair through abdominal or extra-anatomical bypass can be attempted by an experienced vascular surgeon.…”