Endovascular management of secondary aortoduodenal fistula: the importance of gut restoration

Endovascular Treatment of Abdominal Infection-induced Aortoenteric Fistula

Primary aortoenteric fistulas is a rare clinical entity but with fatal outcome, usually arise from atherosclerotic aneurysm, but induced by abdominal infection is extremely rare. We present a case of 54-year-old man with history of Aortic arch replacement and elephant trunk stent implantation 6 years ago for Stanford type A aortic dissection. He underwent enteroscopy and had gastrointestinal perforation during enteroscopy 11 months ago. Since then he had episodes of syncope and Haemorrhage. Finally, a fistula was found on imaging. Endovascular treatment and digestive tract repair was accomplished. At 13-month follow-up, he did not have hematochezia and fever again.

Lumbar artery aneurysm complicated by a fistula between the aneurysm and the duodenum in a patient with Leriche syndrome: A case report

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The arterio-enteric fistula between lumbar artery and duodenum is rare pathology.

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Aneurysm may occur in the collateral circulation in patients with Leriche syndrome.

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Endovascular embolization can control hemorrhage immediately.

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Fistula closure and debridement is recommended for control of local infection.

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Endovascular embolization can serve as a landmark for the debridement of aneurysm.

Introduction

Various collateral pathways maintain blood flow to the lower extremities in patients with Leriche syndrome. The occurrence of true aneurysms in the lumbar artery—a component of an extensive collateral circulation network in patients with Leriche syndrome—is extremely rare.

Presentation of case

A 73-year-old man with Leriche syndrome was diagnosed with lumbar artery aneurysm complicated by a duodenal fistula. The patient underwent endovascular repair, surgical duodenal fistula closure, and debridement of the aneurysm wall until coil exposure.

Discussion

With the same mechanism, patients with aortic occlusive disease may develop an aneurysm and arterio-enteric fistula in the collateral circulation. Combination of treatments may be important for hemostasis, control of infection, and maintaining adequate distal perfusion.

Conclusion

Endovascular embolization can control bleeding as well as serve as a landmark for the debridement of contaminated aneurysm. Surgical fistula closure and aneurysm-wall debridement are useful for control of local infection.

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

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Secondary aortoduodenal fistula is one of life-threatening complication after surgical treatment for abdominal arterial aneurysm.

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The most important factor for acute management is controlling the bleeding from the fistula.

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Intra-aortic balloon occlusion may be one option for management of secondary aortoduodenal fistula.

Introduction

Secondary aortoduodenal fistula (SADF) is a rare but life-threatening complication after aortic reconstruction. Although a number of reports describing treatments for SADF have been published, the optimal management is unclear. A review of the literature suggested methods of reconstruction, control of bleeding, and reduction of infection in the management of SADF. The most important factor for acute intervention is controlling the bleeding from the fistula. We report one case treated using intra-aortic balloon occlusion (IABO) for SADF.

Presentation of a case

We describe a case of secondary aortoduodenal fistula that occurred seven years following aortobifemoral reconstruction for abdominal aortic aneurysm.

Discussion

Early control of bleeding is essential for survival of the patient. Emergency laparotomy or endovascular stenting frequently have been chosen as interventions, although each approach has significant limitations. Emergency laparotomy for patients with hemodynamic instability may create excessive physiologic stress, and endovascular stenting may not be available at every surgical facility. The use of IABO for cases of intraperitoneal bleeding due to trauma has been previously described. IABO is relatively easy to implement, and enabled us to control the bleeding from the aorta more rapidly than other strategies.

Conclusion

Based on a review of the literature and our own experience, IABO should be considered as one option for the management of SADF.

Primary aortoduodenal fistula with a history of distal gastrectomy

Case

A 69‐year‐old man was transferred to our hospital because of an aortoduodenal fistula with hematemesis and pre‐shock vital signs. He had a history of alcoholism, malnutrition, and distal gastrectomy and Billroth I reconstruction. Endovascular aneurysm repair was successfully carried out; however, the presence of comorbidities affected further radical treatment.

Outcome

The patient survived for 2 months postoperatively.

Conclusion

Endovascular aneurysm repair is a useful first‐line treatment for high‐risk aortoduodenal fistula patients; however, it requires improvement for long‐term outcomes in complicated high‐risk cases.