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Georgeades C, Zarb R, Lake Z, Wood J, Lewis B. Primary Aortoduodenal Fistula: A Case Report and Current Literature Review. Ann Vasc Surg 2021; 74:518.e13-518.e23. [PMID: 33549801 DOI: 10.1016/j.avsg.2020.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/27/2020] [Accepted: 12/30/2020] [Indexed: 02/07/2023]
Abstract
Primary aortoduodenal fistula is a rare, life-threatening pathology that is difficult to diagnose and manage. We present the case of a 64-year-old male with a primary aortoduodenal fistula. Our patient initially underwent an endovascular aneurysm repair at an outside institution before being transferred to our tertiary care center, where he ultimately had definitive management with an extra-anatomic bypass, aortic ligation, duodenal resection with primary anastomosis, and gastrojejunostomy tube placement. His surgical cultures grew Candida albicans, and he was discharged with a 6-week course of intravenous antibiotics with subsequent antibiotic suppression for 1 year. He died 14 months postoperatively from tongue squamous cell carcinoma. We also review the current literature regarding epidemiology, pathology, diagnostics, management, and case reports from 2015 to present. Overall, timely diagnosis and treatment is imperative for reducing mortality from primary aortoduodenal fistula, and although formal consensus is lacking regarding most clinical aspects, an increasing number of case reports has helped describe options for management.
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Affiliation(s)
- Christina Georgeades
- Department of Vascular Surgery, Milwaukee Veterans Affairs Medical Center, Milwaukee, WI; Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
| | - Rakel Zarb
- Department of Plastic Surgery, Milwaukee Veterans Affairs Medical Center, Milwaukee, WI; Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Zoe Lake
- Department of Vascular Surgery, Milwaukee Veterans Affairs Medical Center, Milwaukee, WI; Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Jacob Wood
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, NC
| | - Brian Lewis
- Department of Vascular Surgery, Milwaukee Veterans Affairs Medical Center, Milwaukee, WI; Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
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2
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De Smet A, van den Eynde W, Peeters P, Verbist J. Endovascular treatment of a primary aortoduodenal fistula. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 59:844-845. [PMID: 30497234 DOI: 10.23736/s0021-9509.17.09661-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anthony De Smet
- Department of Vascular Surgery, Imelda Hospital, Bonheiden, Belgium
| | | | - Patrick Peeters
- Department of Vascular Surgery, Imelda Hospital, Bonheiden, Belgium
| | - Jürgen Verbist
- Department of Vascular Surgery, Imelda Hospital, Bonheiden, Belgium -
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3
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Chuter TA, Parodi JC, Lawrence-Brown M. Management of Abdominal Aortic Aneurysm: A Decade of Progress. J Endovasc Ther 2016. [DOI: 10.1177/15266028040110s611] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Since the world was first introduced to the concept of endovascular aneurysm repair by Parodi's landmark procedures in 1990, stent-grafts have assumed a prominent role in the management of abdominal aortic aneurysm. Most modern systems are trackable, accurate, and secure. The resulting endovascular procedure is safe, durable, effective, and versatile. Perhaps the most significant increment in the applicability of the endovascular technique was achieved by the development of bifurcated stent-grafts, which dispensed with inadequate distal aortic implantation sites. Additional branches and fenestrations now permit endovascular repair in cases of thoracoabdominal, pararenal, juxtarenal, and bilateral iliac aneurysms. These advances in device performance have been accompanied by a rapid dissemination of necessary skills, leading to the development of a new superspecialty of vascular therapy, with elements of vascular surgery, interventional radiology, and interventional cardiology.
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Affiliation(s)
| | - Juan C. Parodi
- Washington University School of Medicine, St. Louis, Missouri, USA
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4
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Knape S, Van Nieuwenhove Y, van Tussenbroek F, Van den Brande P, Delvaux G. Endovascular Techniques in the Management of Acute Arterioenteric Fistulas. J Endovasc Ther 2016; 11:89-93. [PMID: 14748623 DOI: 10.1177/152660280401100112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report the use of endovascular techniques to emergently treat hemorrhagic complications of rare arterioenteric fistulas. Case Reports: Two patients, a 71-year-old man and a 61-year-old woman, presented with acute bleeding arising from primary arterioenteric fistulas. In the first patient, a fistula between the iliac artery and the small intestine complicated laparoscopic treatment of acute appendicitis. In the second patient, irradiation of a metastatic cervical carcinoma led to a fistula between the right iliac artery and the terminal ileum. In both patients, the hemorrhage was controlled with implantation of a Jostent Peripheral Stent-Graft. The man is alive at 3 years with a patent endograft, but the woman died 1 month after treatment from complications of tumor progression. Conclusions: Endovascular application of covered stents provides an alternative treatment, avoiding extensive surgery. In cases of neoplastic erosion of a large vessel, endovascular stenting can offer a palliative solution.
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Affiliation(s)
- Susanne Knape
- Department of Surgery, University Hospital, Vrije Universiteit Brussel, Brussels, Belgium
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5
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Lyden SP, Tanquilut EM, Gavin TJ, Adams JE. Aortoduodenal Fistula after Abdominal Aortic Stent Graft Presenting with Extremity Abscesses. Vascular 2016; 13:305-8. [PMID: 16288707 DOI: 10.1258/rsmvasc.13.5.305] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Aortoenteric fistula (AEF) has been described after endovascular stent graft repair of abdominal aortic aneurysms (EVAR). AEF after EVAR has been associated with aneurysm growth, endoleak, migration, and aortic inflammation. We report a patient with an AEF presenting 2 years after EVAR with two abscesses in the right leg. A computed tomographic scan showed a gas-filled thrombus lining the right limb of his graft. At conversion, no endoleak, device migration, or residual aneurysm sac was found. AEF can occur after endoluminal stent graft (ELG) in the absence of aneurysm growth, endoleak, migration, or inflammation. AEF can cause ELG infection and extremity infection.
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Affiliation(s)
- Sean P Lyden
- Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA.
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Chisci E, de Donato G, Setacci F, Stella A, Setacci C. Recurrent Aortoenteric Fistula: Two Different Bridge Solutions. Vascular 2016; 15:235-7. [PMID: 17714642 DOI: 10.2310/6670.2007.00033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A “recurrent” aortoenteric fistula (AEF) is very rare and in literature anecdotic. Currently, graft excision and extra-anatomic bypass are considered the treatments of choice, but are associated with significant mortality and morbidity. Herein, we describe the case of a “recurrent” AEF treated before definitive extra-anatomic bypass, by two different, staged bridge solutions: allograft in situ replacement and endovascular grafting. At 1, 3 and 6-month follow-up, the patient was asymptomatic and normally active.
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Affiliation(s)
- Emiliano Chisci
- Vascular and Endovascular Surgery Unit, Department of Surgery, University of Siena, Siena, Italy.
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7
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Philippakis GE, Moustardas M. Surgical treatment of primary aortojejunal fistula. Int J Surg Case Rep 2013; 4:477-9. [PMID: 23557938 DOI: 10.1016/j.ijscr.2013.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 01/30/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Primary aortoenteric fistula is a rare clinical situation with a high mortality rate. One should suspect that condition when an abdominal aortic aneurysm is known to be present. We describe the case of a 60 year old man who presented with upper gastrointestinal bleeding as the first and sole manifestation of an abdominal aortic aneurysm, due to the rupture of the aneurysm in the jejunum. PRESENTATION OF CASE The patient was admitted with hematemesis and melena. He reported no abdominal pain. Upper gastrointestinal endoscopy disclosed no bleeding or lesions of the stomach and duodenum. Bleeding stopped the following day, only to recur 4 days later. The patient was then subjected to abdominal CT scan, which revealed the presence of a subrenal aortic aneurysm, with fistulization to the small intestine. At laparotomy the aortic aneurysm was adherent to the first centimeters of jejunum. The diseased aorta was excised and replaced with a Dacron Y graft in situ. DISCUSSION Primary aortojejunal fistulas are only rarely encountered. They usually are the result of a nonspecific aneurysm of the abdominal aorta. They usually manifest with premonitory bleeding, followed by catastrophic hemorrhage few days later. Even with surgery the mortality rate is high. CONCLUSION Diagnosis of primary aortoenteric fistula requires a high index of suspicion in cases of upper gastrointestinal bleeding, especially when endoscopy is negative and there is no knowledge of the existence of an abdominal aortic aneurysm. CT scan and prompt surgery are crucial to the survival of these patients.
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Sarac M, Marjanovic I, Bezmarevic M, Zoranovic U, Petrovic S, Mihajlovic M. An aortoduodenal fistula as a complication of immunoglobulin G4-related disease. World J Gastroenterol 2012; 18:6164-7. [PMID: 23155348 PMCID: PMC3496896 DOI: 10.3748/wjg.v18.i42.6164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/02/2012] [Accepted: 07/09/2012] [Indexed: 02/06/2023] Open
Abstract
Most primary aortoduodenal fistulas occur in the presence of an aortic aneurysm, which can be part of immunoglobulin G4 (IgG4)-related sclerosing disease. We present a case who underwent endovascular grafting of an aortoduodenal fistula associated with a high serum IgG4 level. A 56-year-old male underwent urgent endovascular reconstruction of an aortoduodenal fistula. The patient received antibiotics and other supportive therapy, and the postoperative course was uneventful, however, elevated levels of serum IgG, IgG4 and C-reactive protein were noted, which normalized after the introduction of steroid therapy. Control computed tomography angiography showed no endoleaks. The primary aortoduodenal fistula may have been associated with IgG4-related sclerosing disease as a possible complication of IgG4-related inflammatory aortic aneurysm. Endovascular grafting of a primary aortoduodenal fistula is an effective and minimally invasive alternative to standard surgical repair.
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9
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Farres H, Gonzales AJ, Garrett HE. Aortoduodenal fistula after endograft repair of abdominal aortic aneurysm secondary to a retained guidewire. J Vasc Surg 2012; 56:1413-5. [DOI: 10.1016/j.jvs.2012.05.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/09/2012] [Accepted: 05/09/2012] [Indexed: 11/28/2022]
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Abstract
An aortoenteric fistula (AEF) is a communication between the aorta and an adjacent loop of the bowel. The three most useful diagnostic modalities for detecting AEF are abdominal computed tomography scan with intravenous contrast, esophagogastroduodenoscopy, and arteriography. The treatment of AEFs has improved in recent years, but despite the multiple surgical techniques reported, many of the patients do not survive or are left debilitated after treatment. Endovascular repair is an efficient and safe method to stabilize patients with life-threatening AEFs. The aim of this study is to provide a comprehensive and synthetic review of the latest advantages on the diagnosis and management of primary and secondary AEF.
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Open or Endovascular Repair of Aortoenteric Fistulas? A Multicentre Comparative Study. Eur J Vasc Endovasc Surg 2011; 41:625-34. [DOI: 10.1016/j.ejvs.2010.12.026] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 12/30/2010] [Indexed: 11/23/2022]
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12
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Shehzad KN, Riaz A, Meyrick-Thomas J. Primary aortoduodenal fistula - a rare clinical entity. JRSM SHORT REPORTS 2010; 1:7. [PMID: 21103099 PMCID: PMC2984333 DOI: 10.1258/shorts.2009.090430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Khalid N Shehzad
- Department of General Surgery, Watford General Hospital , Vicarage Road, Watford WD18 0HB , UK
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Antoniadis P, Geropapas G, Kounougeri E, Staramos D, Kalamaras A, Dervisis K. Acutely Bleeding Aortoduodenal Fistula: Staged Endovascular and Open Surgical Repair. Vascular 2009; 17:197-200. [DOI: 10.2310/6670.2009.00033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Secondary aortoduodenal fistula is an uncommon but potentially fatal complication that can occur after aortic reconstruction surgery and usually presents with upper gastrointestinal hemorrhage. Taking into account the accompanying multiple comorbidities of those patients, conventional open surgical repair carries with it significant mortality and morbidity rates. The purpose of this case report is to describe the successful combined endovascular and open surgical repair of an acutely ruptured aortoduodenal fistula in a 67-year-old male patient. Four months after the procedure, the patient remains well.
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Affiliation(s)
- Pavlos Antoniadis
- *Department of Vascular Surgery, Konstantopoulio General Hospital “Agia Olga,” N.Ionia, Athens, Greece; †ICU of Konstantopoulio General Hospital “Agia Olga,” N.Ionia, Athens, Greece
| | - George Geropapas
- *Department of Vascular Surgery, Konstantopoulio General Hospital “Agia Olga,” N.Ionia, Athens, Greece; †ICU of Konstantopoulio General Hospital “Agia Olga,” N.Ionia, Athens, Greece
| | - Ekaterini Kounougeri
- *Department of Vascular Surgery, Konstantopoulio General Hospital “Agia Olga,” N.Ionia, Athens, Greece; †ICU of Konstantopoulio General Hospital “Agia Olga,” N.Ionia, Athens, Greece
| | - Dimitrios Staramos
- *Department of Vascular Surgery, Konstantopoulio General Hospital “Agia Olga,” N.Ionia, Athens, Greece; †ICU of Konstantopoulio General Hospital “Agia Olga,” N.Ionia, Athens, Greece
| | - Alexios Kalamaras
- *Department of Vascular Surgery, Konstantopoulio General Hospital “Agia Olga,” N.Ionia, Athens, Greece; †ICU of Konstantopoulio General Hospital “Agia Olga,” N.Ionia, Athens, Greece
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14
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Jayarajan S, Napolitano LM, Rectenwald JE, Upchurch GR. Primary aortoenteric fistula and endovascular repair. Vasc Endovascular Surg 2009; 43:592-6. [PMID: 19640906 DOI: 10.1177/1538574409335275] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary aortoenteric fistulae are difficult conditions to diagnose and manage. A 35-year-old male developed massive upper gastrointestinal hemorrhage due to a primary aortoduodenal fistula. Previous radiation therapy and retroperitoneal lymph node dissection for germ cell cancer with resultant dense retroperitoneal fibrosis made open aortic repair impossible. Endovascular balloon occlusion of the aorta and stent graft repair of the primary aortoduodenal fistula was performed. At 1-year follow-up, there is no clinical or radiographic evidence of stent-graft infection. Endovascular techniques and repair are important approaches to consider during the management of complicated primary aortoenteric fistulae when open surgical repair is not feasible.
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Affiliation(s)
- Senthil Jayarajan
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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15
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Outcome after endovascular stent graft repair of aortoenteric fistula: A systematic review. J Vasc Surg 2008; 49:782-9. [PMID: 19028054 DOI: 10.1016/j.jvs.2008.08.068] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 08/04/2008] [Accepted: 08/26/2008] [Indexed: 12/25/2022]
Abstract
BACKGROUND Aortoenteric fistula (AEF) is a critical clinical condition, which may present with gastrointestinal hemorrhage, with or without signs of sepsis. Conventional open surgical repair is associated with high morbidity and mortality. Endovascular stent graft repair has been attempted, but recurrent infection remains of major concern. We conducted a systematic review to assess potential factors associated with poor outcome after endovascular treatment. METHODS The English literature was searched using the MEDLINE electronic database up to April 2008. All studies reporting on the primary management of primary or secondary AEF with endovascular stent graft repair were considered. RESULTS Data were extracted from 33 reports that included 41 patients and were entered in the final analysis. Persistent/recurrent/new infection or recurrent hemorrhage developed in 44% of the patients, after a mean follow-up period of 13 months (range, 0.13-36). Secondary, as compared to primary, AEF had an almost threefold increased risk of persistent/recurrent infection. Evidence of sepsis preoperatively was found to be a factor indicating unfavorable outcome (P < .05). Persistent/recurrent/new infection after treatment was associated with worse 30-day and overall survival compared with those who did not develop sepsis (P < .05). CONCLUSION Endovascular stent graft repair of AEF was associated with a high incidence of infection or recurrent bleeding postoperatively. Evidence of sepsis preoperatively was indicating poor outcome.
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Lozano FS, Muñoz-Bellvis L, San Norberto E, Garcia-Plaza A, Gonzalez-Porras JR. Primary aortoduodenal fistula: new case reports and a review of the literature. J Gastrointest Surg 2008; 12:1561-5. [PMID: 18301952 DOI: 10.1007/s11605-008-0499-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 02/05/2008] [Indexed: 01/31/2023]
Affiliation(s)
- Francisco S Lozano
- Angiology and Vascular Surgery, University Hospital of Salamanca, Paseo de San Vicente, 58-182, Salamanca, 37007, Spain.
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17
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Endovascular Management of Acute Bleeding Arterioenteric Fistulas. Cardiovasc Intervent Radiol 2008; 31:542-9. [DOI: 10.1007/s00270-007-9267-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Revised: 10/10/2007] [Accepted: 11/15/2007] [Indexed: 11/26/2022]
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Papacharalambous G, Skourtis G, Saliveros A, Karagannidis D, Makris S, Panousis P, Ktenidis K. Endovascular treatment of a primary aortoduodenal fistula: 2-year follow-up of a case report. Vasc Endovascular Surg 2007; 41:265-70. [PMID: 17595397 DOI: 10.1177/1538574407300919] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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.
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Danneels MIL, Verhagen HJM, Teijink JAW, Cuypers P, Nevelsteen A, Vermassen FEG. Endovascular repair for aorto-enteric fistula: a bridge too far or a bridge to surgery? Eur J Vasc Endovasc Surg 2006; 32:27-33. [PMID: 16427330 DOI: 10.1016/j.ejvs.2005.11.031] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2005] [Accepted: 11/18/2005] [Indexed: 12/22/2022]
Abstract
PURPOSE To review our experience of endovascular treatment of aorto-enteric fistula (AEF). METHODS Between March 1999 and March 2005, 15 patients in five university and teaching hospitals in Belgium and The Netherlands were treated for AEF by endovascular repair. Twelve (80%) were male. The mean age was 67 years. Thirteen (87%) had had previous aortic or iliac surgery, 1.7-307 months before. All patients showed clinical or biochemical signs of bleeding. Eight (53%) were in shock, five (33%) had systemic signs of infection. Eight (53%) patients were treated in an emergency setting. Ten (67%) were treated with an aortouniiliac device, three (20%) with an aortobiiliac device, one with a tube graft and one with occluders only. All patients received antibiotics postoperatively for a prolonged period of time. RESULTS All AEF were successfully sealed, the 30-days mortality was nil. Mean hospital stay was 20 (2-81) days. One patient died 2.7 months later of postoperative complications, one died of lung cancer. Until now, there are no signs of reinfection in four (27%) patients (mean follow-up 15.7 (1-44) months). However, reinfection or recurrent AEF occurred in nine (60%) patients after 9.5 (0.61-31) months. Seven patients were reoperated successfully, two patients died after reintervention. CONCLUSION Endovascular sealing of AEF is a promising technique, which provides time to treat shock, local and systemic infection, and co-morbidity. This creates a better situation to perform open repair in the future with possibly better outcome. Danger of reinfection remains high. Endovascular sealing of AEF should, therefore, be seen as a bridge to open surgery when possible.
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Abstract
BACKGROUND A primary aortoenteric fistula (PAEF) is a rare clinical entity that results in fatal exsanguination if undiagnosed. The present study investigates whether management and survival have altered over time. METHODS A Medline search was conducted for the period from January 1994 to December 2003. Data were categorized and compared with reviews of PAEF published before this interval. RESULTS The classical triad (gastrointestinal bleeding, pain and a pulsating mass) was present in only 11 per cent of 81 patients. Most PAEFs were caused by an aneurysmal aorta and were almost always (94 per cent) heralded by repetitive gastrointestinal bleeds. Computed tomography (CT) provides images superior to those of other diagnostic modalities, such as gastroduodenoscopy or conventional angiography. Operative mortality rates were lower in later years possibly owing to improvements in perioperative care and the advent of endovascular techniques. CONCLUSION Gastrointestinal bleeding combined with a negative endoscopy in the presence of an aneurysmal aorta suggests PAEF and requires urgent evaluation by CT. Endovascular operation is an attractive treatment option.
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Affiliation(s)
- S J F Saers
- Department of Surgery, Máxima Medical Centre Veldhoven, de Run 4600, 5500 MB Veldhoven, The Netherlands
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González-Fajardo JA, Gutiérrez V, Martín-Pedrosa M, Del Rio L, Carrera S, Vaquero C. Endovascular Repair in the Presence of Aortic Infection. Ann Vasc Surg 2005; 19:94-8. [PMID: 15714375 DOI: 10.1007/s10016-004-0144-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study is to describe our experience in the endovascular management of two cases of aortoenteric and aortoesophageal fistula that were unsuccessfully treated with an aortic stent graft because of recurrent infection. Although endovascular repair appears to be a promising therapeutic modality, in the presence of infection this technique should be considered on an individual basis. Failure of treatment should be expected in a significant number of cases during follow-up, particularly in patients with signs of sepsis. A review of the literature with positive and negative results has been included for a better understanding of this condition.
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Affiliation(s)
- José A González-Fajardo
- Division of Vascular Surgery, Hospital Clinico Universitario of Valladolid, Valladolid, Spain.
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Chuter TAM, Parodi JC, Lawrence-Brown M. Management of Abdominal Aortic Aneurysm: A Decade of Progress. J Endovasc Ther 2004. [DOI: 10.1583/04-1388.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Knape S, Van Nieuwenhove Y, Van Tussenbroek F, Van den Brande P, Delvaux G. Endovascular Techniques in the Management of Acute Arterioenteric Fistulas. J Endovasc Ther 2004. [DOI: 10.1583/1545-1550(2004)011<0089:etitmo>2.0.co;2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tomlinson MA, Gold B, Thomas MH, Browning NG. Endovascular stent graft repair of a recurrent aorto-enteric fistula. Eur J Vasc Endovasc Surg 2002; 24:459-61. [PMID: 12435349 DOI: 10.1053/ejvs.2002.1720] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M A Tomlinson
- Department of Vascular Surgery, St Peter's Hospital, Chertsey, Surrey, UK
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25
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Aortoenteric Fistula in Advanced Germ Cell Tumor: A Rare Lethal Complication. J Urol 2002. [DOI: 10.1097/00005392-200205000-00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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27
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Allen RC, Sebastian MG. The role of endovascular techniques in aortoesophageal fistula repair. J Endovasc Ther 2001; 8:602-3. [PMID: 11797976 DOI: 10.1177/152660280100800612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R C Allen
- Cleveland Clinic Florida-Naples, 34119, USA.
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Bond SE, McGuinness CL, Reidy JF, Taylor PR. Repair of secondary aortoesophageal fistula by endoluminal stent-grafting. J Endovasc Ther 2001; 8:597-601. [PMID: 11797975 DOI: 10.1177/152660280100800611] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe a case of secondary aortoesophageal fistula that was treated with an endoluminal stent-graft. CASE REPORT A 58-year-old woman presented with hematemesis and melena. In 1974 she had an interposition graft repair of an aortic transection sustained during a traffic accident. At the examination in 1998, angiography demonstrated a mechanical disruption of the proximal anastomosis forming an aortoesophageal fistula. A 28-mm x 3.75-cm AneuRx stent-graft was introduced via a right femoral arteriotomy and deployed across the defect. Follow-up CT scans at 18 months showed exclusion of the false aneurysm with no evidence of infection; the patient remains well at >2 years after stent-graft implantation. CONCLUSIONS Endoluminal repair can be successful in achieving a satisfactory midterm outcome in cases of secondary aortoesophageal fistula.
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Affiliation(s)
- S E Bond
- Department of Surgery, Guy's & St. Thomas' Hospital Trust, London, England, UK
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Bond SE, McGuinness CL, Reidy JF, Taylor PR. Repair of Secondary Aortoesophageal Fistula by Endoluminal Stent-Grafting. J Endovasc Ther 2001. [DOI: 10.1583/1545-1550(2001)008<0597:rosafb>2.0.co;2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Krämer S, Pamler R, Seifarth H, Gabelmann A, Brambs HJ, Sunder-Plassmann L, Görich J. Endovascular Grafting of Traumatic Aortic Aneurysms in Contaminated Fields. J Endovasc Ther 2001. [DOI: 10.1583/1545-1550(2001)008<0262:egotaa>2.0.co;2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Krämer S, Pamler R, Seifarth H, Brambs HJ, Sunder-Plassmann L, Görich J. Endovascular grafting of traumatic aortic aneurysms in contaminated fields. J Endovasc Ther 2001; 8:262-7. [PMID: 11491260 DOI: 10.1177/152660280100800305] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the potential of endovascular stent-grafts to treat traumatic aortic lesions in contaminated areas. METHODS Four patients (3 women; ages 26-78 years) underwent stent-grafting to repair an aortic rupture sustained in a motorcycle accident, aortic lacerations secondary to surgical treatment of spondylitis in 2 patients, and an aortobronchial fistula following surgical thoracic aortic repair 10 years earlier. Stent-grafts (2 Corvita, 1 Talent, and 1 Vanguard) were placed endoluminally into the infected areas via a transfemoral approach. Follow-up included erythrocyte sedimentation rate, white blood count, C-reactive protein, blood cultures, and computed tomography (CT). RESULTS The stent-grafts were successfully placed in all cases and excluded the aortic lesion. Under supportive antibiotic therapy, inflammation parameters returned to normal. CT imaging showed no evidence of paraprosthetic infection, nor were there any other complications over a follow-up that ranged from 3 to 34 months. CONCLUSIONS Endovascular therapy may be an alternative in the acute management of aortic ruptures in the setting of infection. Long-term results are required for definitive evaluation of the method.
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Affiliation(s)
- S Krämer
- Department of Radiology, University of Ulm, Germany.
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