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Endovascular Management of Bleeding Aortoenteric Fistula May be Feasible as a Definitive Repair

Published:January 29, 2022DOI:https://doi.org/10.1016/j.avsg.2022.01.009
      Aorto-enteric fistula (AEF) is a complication with devastating sequelae and significant morbidity. Although open surgery remains primary treatment endovascular approach may be used as a temporary bridge but rarely as a definitive therapy. We present a case of a patient who presented with a secondary AEF, due to hemodynamic instability we chose to treat the fistula with an aortic endograft. The patient underwent bowel resection due to bowel obstruction with omental patch over the aortic rent, 6 weeks of antibiotics. Patient is now at 8-year follow-up without evidence of infection. Although there is scarce literature on this topic, endovascular treatment of bleeding AEF may be feasible as a definitive option. Due to high risk of graft infection we recommend close observation and suppressive antibiotics.
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      References

        • Voorhoeve R
        • Moll FL
        • de Letter JA
        • et al.
        Primary aortoenteric fistula: report of eight new cases and review of the literature.
        Ann Vasc Surg. 1996; 10: 40-48
        • Elliott JP
        • Smith RF
        • Szilagyi DE.
        Aortoenteric and paraprostheticenteric fistulas.
        Arch Surg. 1974; 108: 479-490
        • Thompson WM
        • Jackson DC
        • Johnsrude IS.
        Aortoenteric and paraprosthetic-enteric fistulas: radiologic findings.
        AJR Am J Roentgenol. 1976; 127: 235-242
        • Plate G
        • Hollier LA
        • O'Brien P
        • et al.
        Recurrent aneurysms and late vascular complications following repair of abdominal aortic aneurysms.
        Arch Surg. 1985; 120: 590-594
        • Bergqvist D
        • Alm A
        • Claes G
        • et al.
        Secondary aortoenteric fistulas— an analysis of 42 cases.
        Eur J Vasc Surg. 1987; 1: 11-18
        • Bergeron P
        • Espinoza H
        • Rudondy P
        • et al.
        Secondary aortoenteric fistulas: value of initial axillofemoral bypass.
        Ann Vasc Surg. 1991; 5: 4-7
        • Champion MC
        • Sullivan SN
        • Coles JC
        • et al.
        Aortoenteric fistula. Incidence, presentation, recognition and management.
        Ann Surg. 1982; 195: 314-317
        • Higgins SD
        • Steed DL
        • Julian TB
        • et al.
        Management of aortoenteric paraprosthetic fistulae.
        J Cardiovasc Surg. 1990; 31: 81-86
        • Peck JJ
        • Eidemiler LR.
        Aortoenteric fistulas.
        Arch Surg. 1992; 127: 1191-1194
        • Pipinos II
        • Carr JA
        • Haithcock BE
        • et al.
        Secondary aortoenteric fistula.
        Ann Vasc Surg. 2000; 14: 688-696
        • Kuestner LM
        • Reilly LM
        • Jicha DL
        • et al.
        Secondary aortoenteric fistula: contemporary outcome using extraanatomic bypass and infected graft excision.
        J Vasc Surg. 1995; 21: 184-196
        • McCann RL
        • Schwartz LB
        • Georgiade GS.
        Management of abdominal aortic graft complications.
        Ann Surg. 1993; 217: 729-734
        • Perdue GD
        • Smith RB
        • Ansley JD
        • et al.
        Impending aortoenteric hemorrhage: the effect of early recognition on improved outcome.
        Ann Surg. 1980; 192: 237-243
        • Trout III, HH
        • Kozloff L
        • Giordano JM.
        Priority of revascularization in patients with graft enteric fistulas, infected arteries, or infected arterial prostheses.
        Ann Surg. 1984; 199: 669-683
        • Umpleby HC
        • Britton DC
        • Turnbull AR.
        Secondary arterio-enteric fistulae: a surgical challenge.
        Br J Surg. 1987; 74: 256-259
        • Yeager RA
        • McConnell DB
        • Sasaki TM
        • et al.
        Aortic and peripheral prosthetic graft infection: differential management and causes of mortality.
        Am J Surg. 1985; 150: 36-43
        • Jacobs MJHM
        • Reul GJ
        • Gregoric I
        • et al.
        In-situ replacement and extra-anatomic bypass for the treatment of infected abdominal aortic grafts.
        Eur J Vasc Surg. 1991; 5: 83-86
        • Lundbom J
        • Andresande E
        • HO Myhre
        Aortoduodenal fistula reconstructed with autogenous tissue: case report.
        Acta Chir Scand. 1989; 155: 545-547
        • O'Mara CS
        • Williams GM
        • Ernst CB.
        Secondary aortoenteric fistula: a 20-year experience.
        Am J Surg. 1981; 142: 203-209
        • Ricotta JJ
        • Faggioli GL
        • Stella A
        • et al.
        Total excision and extraanatomic bypass for aortic graft infection.
        Am J Surg. 1991; 162: 145-149
        • Chuter TAM
        • Lukaszewicz GC
        • Reilly LM
        • et al.
        Endovascular repair of a presumed aortoenteric fistula: late failure due to recurrent infection.
        J Endovasc Ther. 2000; 7: 240-244
        • Curti T
        • Freyrie A
        • Mirelli M
        • et al.
        Endovascular treatment of an ilio-enteric fistula: a “bridge” to aortic homograft.
        Eur J Vasc Endovasc Surg. 2000; 20: 204-206
        • Kinney EV
        • Kaebnick HW
        • Mitchell RA
        • et al.
        Repair of mycotic paravisceral aneurysm with a fenestrated stent graft.
        J Endovasc Ther. 2000; 7: 192-197
        • Grabs AJ
        • Irvine CD
        • Lusby RJ.
        Stent-graft treatment for bleeding from a presumed aortoenteric fistula.
        J Endovasc Ther. 2000; 7: 236-239
        • Deshpande A
        • Lovelock M
        • Mossop P
        • et al.
        Endovascular repair of an aortoenteric fistula in a high-risk patient.
        J Endovasc Surg. 1999; 6: 379-384
        • Burks
        • et al.
        Endovascular repair of bleeding aortoendteric fistulas: a 5-year experience.
        J Vasc Surg. 2001; 34: 6
        • Beuran M
        • et al.
        Primary Aortoduodenal fistula.
        Braz J Cardiovasc Surg. 2016; 31: 261-263