Abstract:Aortoenteric fistula (AEF) after endovascular aortic repair (EVAR) is a rare complication, with only 32 cases reported previously. A 71-year-old man who presented with severe duodenal bleeding due to primary AEF (PAEF) underwent successful EVAR. Four years later, the AEF recurred because of dilatation of the aneurysm sac. He underwent emergent surgery, removal of the stent graft, and replacement of an artificial bifurcated graft with placement of a greater omental flap. EVAR for PAEF was an effective option fo… Show more
“…Unfortunately, the graft explant was not sent for culture and we cannot exclude the contribution of odontogenic and other bacteria to re-fistulisation. The process of fistulisation is complex, and no definitive infectious cause may be found even after culture [ 3 , 4 ].…”
Section: Discussionmentioning
confidence: 99%
“…To our knowledge, Arima et al. [ 3 ] describe the only other case of secondary AEF occurring after primary AEF. In this analogous case, an endovascular approach was used to manage the primary fistula.…”
Section: Introductionmentioning
confidence: 99%
“…In this analogous case, an endovascular approach was used to manage the primary fistula. Secondary AEF occurred in the setting of persistent type 2 endoleak and an enlarged aneurysmal sac, with the explanted graft not yielding any organisms after culture [ 3 ]. We acknowledge the high chance of reporting bias but suggest that these two cases should prompt caution regarding the use of EVAR in the definitive management of AEF, as ongoing infection at the repair site is likely to lead to re-fistulisation [ 1 , 3–5 ].…”
We report the case of an 80-year-old male with stage three kidney disease, who survived a primary aorto-enteric fistula (AEF) in the setting of chronic Q fever after presenting with melena and syncope. His initial surgical treatment included endovascular aortic repair. Type 2 endoleak was present post-operatively. Six months later, he was diagnosed with a secondary AEF after syncope and large volume hematemesis. He was definitively treated with an open explant of his stent, repair of the duodenum and bilateral axillofemoral bypass. Two years later, he remains active and independent on life-long antibiotics.
“…Unfortunately, the graft explant was not sent for culture and we cannot exclude the contribution of odontogenic and other bacteria to re-fistulisation. The process of fistulisation is complex, and no definitive infectious cause may be found even after culture [ 3 , 4 ].…”
Section: Discussionmentioning
confidence: 99%
“…To our knowledge, Arima et al. [ 3 ] describe the only other case of secondary AEF occurring after primary AEF. In this analogous case, an endovascular approach was used to manage the primary fistula.…”
Section: Introductionmentioning
confidence: 99%
“…In this analogous case, an endovascular approach was used to manage the primary fistula. Secondary AEF occurred in the setting of persistent type 2 endoleak and an enlarged aneurysmal sac, with the explanted graft not yielding any organisms after culture [ 3 ]. We acknowledge the high chance of reporting bias but suggest that these two cases should prompt caution regarding the use of EVAR in the definitive management of AEF, as ongoing infection at the repair site is likely to lead to re-fistulisation [ 1 , 3–5 ].…”
We report the case of an 80-year-old male with stage three kidney disease, who survived a primary aorto-enteric fistula (AEF) in the setting of chronic Q fever after presenting with melena and syncope. His initial surgical treatment included endovascular aortic repair. Type 2 endoleak was present post-operatively. Six months later, he was diagnosed with a secondary AEF after syncope and large volume hematemesis. He was definitively treated with an open explant of his stent, repair of the duodenum and bilateral axillofemoral bypass. Two years later, he remains active and independent on life-long antibiotics.
“…Given that there have been cases of re-fistulisation and reinfection following prosthetic aortic repair, long-term close follow-up is warranted. 11 , 12 …”
Endovascular aneurysm repair (EVAR) is a minimally invasive treatment proposed as an alternative to open repair in patients with abdominal aortic aneurysms. EVAR consists in a stent-graft placement within the aorta in order to exclude the aneurysm from arterial circulation and reduce the risk of rupture. Knowledge of the various types of devices is mandatory because some stents/grafts are more frequently associated with complications. CT angiography is the gold standard diagnostic technique for preprocedural planning and postprocedural surveillance. EVAR needs long-term follow-up due to the high rate of complications. Complications can be divided in endograft device-related and systemic complications. The purpose of this article is to review the CT imaging findings of EVAR complications and the key features for the diagnosis.
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