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Chou JW, Cheng KS, Chuang SC. An unusual cause of distal duodenal bleeding. Intest Res 2016; 14:197-8. [PMID: 27175123 PMCID: PMC4863056 DOI: 10.5217/ir.2016.14.2.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jen-Wei Chou
- School of Medicine, China Medical University, Taichung, Taiwan, Republic of China.; Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, Republic of China.; Taiwan Society of Inflammatory Bowel Disease (TSIBD), Taiwan, Republic of China.; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), Taiwan, Republic of China
| | - Ken-Sheng Cheng
- School of Medicine, China Medical University, Taichung, Taiwan, Republic of China.; Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Shih-Chieh Chuang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, Republic of China
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Keunen B, Houthoofd S, Daenens K, Hendriks J, Fourneau I. A Case of Primary Aortoenteric Fistula: Review of Therapeutic Challenges. Ann Vasc Surg 2016; 33:230.e5-230.e13. [PMID: 26965800 DOI: 10.1016/j.avsg.2015.11.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 11/17/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUNDS Primary aortoenteric fistula (PAEF) is a lethal cause of gastrointestinal bleeding. They mainly originate from eroding abdominal aortic aneurysms into the intestinal wall. Other known causes involve malignancies, infection, corpora aliena, or radiation therapy. Traditional treatment consists of resection of the fistula and extra-anatomic reconstruction. In situ repair and endovascular stenting have offered new therapeutic options in managing this complex entity. CASE REPORT A 79-year-old woman presented with a PAEF. She was known with a 3.9-cm abdominal aortic aneurysm and polymyalgia rheumatica. The initial treatment consisted of endovascular stenting. Several months later, she presented with persistent inflammation of the aortic endoprosthesis. The prosthesis and inflammatory tissue were resected, and in situ reconstruction with autologous superficial femoral vein and omentoplasty was performed. Two years later, she remains well with no evidence for infection or bleeding. CONCLUSIONS Polymyalgia rheumatica might induce an AEF as in this patient no other provoking factors were retained. The different therapeutic options all have their advantages and disadvantages. In line with this case, we suggest an individualized approach for AEFs. In case of precarious hemodynamical state or life expectancy, endovascular treatment is indicated. Afterward, the possibility and/or necessity of open repair should be discussed. For stable patients with respectable life expectancy in situ repair with autologuous vein or rifampicin-soaked prosthesis (adjusted to comorbidities) might be most appropriate. Extra-anatomic reconstruction still remains a valuable alternative in older patients and in the presence of any other local factors hampering in situ reconstruction.
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Affiliation(s)
- Bram Keunen
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Kim Daenens
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jeroen Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium.
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Smeds MR, Duncan AA, Harlander-Locke MP, Lawrence PF, Lyden S, Fatima J, Eskandari MK, Steenberge SP, Tomita TM, Morasch M, Jim J, Lyons LC, Charlton-Ouw K, Mushtaq H, Leake SS, Motaganahalli R, Nelson P, Parkerson G, Shalhub S, Bove P, Modrall G, Davila V, Money S, Hedayati N, Abou-Zamzam A, Abularrage C, Wittgen C. Treatment and outcomes of aortic endograft infection. J Vasc Surg 2016; 63:332-40. [DOI: 10.1016/j.jvs.2015.08.113] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/27/2015] [Indexed: 10/22/2022]
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[Management of bleeding and infections in the context of visceral surgery]. Chirurg 2016; 87:119-27. [PMID: 26801754 DOI: 10.1007/s00104-015-0142-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Bleeding and vascular infections are serious potential complications during abdominal general surgery. The management of bleeding depends on the extent and localization and can range from the application of hemostatics to vascular sutures, interpositioning and ligatures. The use of prosthetic biomaterials implanted endoluminally or during open reconstruction permits palliation of potentially fatal conditions. The overall incidence of infections involving vascular prostheses is relatively low because of routine antibiotic prophylaxis prior to surgery, refinements in sterilization and packaging of devices and careful adherence to aseptic procedural and surgical techniques. When infections occur detection and definitive therapy of the vascular prosthesis are often delayed and the management is complex and tedious. Infections involving vascular prostheses are difficult to eradicate and in general, surgical therapy is required often coupled with excision of the prosthesis. Keys to success include accurate diagnostics to identify the organism and extent of graft infections, specific long-term antibiotic therapy and well-planned surgical interventions to excise and replace the infected graft and sterilize the local tissue. Regardless of the technique used to eradicate graft infections, success is measured by patient survival, freedom from recurrent infection and patency of revascularization. Even when treatment is successful, the morbidity associated with vascular graft infections is considerable. Aortoenteric fistulas (AEF) are a rare (incidence < 1.5 %) but often fatal complication. Primary diagnosis of AEF remains difficult. Computed tomography (CT) and fluorodeoxyglucose positron emission tomography CT (FDG-PET-CT) are the diagnostic tools of choice. Therapy consists of an urgent individualized interdisciplinary surgical approach with primary axillofemoral bypass and secondary prosthesis explantation or in situ replacement and subsequent bowel resection. Endovascular aortic repair (EVAR) is reserved for primary aortoenteric fistulas in patients with no signs of infection or in emergency cases as a bridging method.
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55
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Malik MU, Ucbilek E, Sherwal AS. Critical gastrointestinal bleed due to secondary aortoenteric fistula. J Community Hosp Intern Med Perspect 2015; 5:29677. [PMID: 26653698 PMCID: PMC4677592 DOI: 10.3402/jchimp.v5.29677] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 12/22/2022] Open
Abstract
Secondary aortoenteric fistula (SAEF) is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A). The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF.
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Affiliation(s)
- Mohammad U Malik
- Department of Internal Medicine, Conemaugh Memorial Medical Center, Johnstown, PA, USA;
| | - Enver Ucbilek
- Division of Gastroenterology and Hepatology - Transplant Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanpreet S Sherwal
- Department of General Surgery, Conemaugh Memorial Medical Center, Johnstown, PA, USA
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Use of Aortic Occluders and Endovascular Plugs in a 2-step Hybrid Treatment of Secondary Aortoenteric Fistulas. Ann Vasc Surg 2015; 30:310.e9-15. [PMID: 26522586 DOI: 10.1016/j.avsg.2015.07.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/14/2015] [Accepted: 07/20/2015] [Indexed: 11/24/2022]
Abstract
Aortoenteric fistula (AEF) is a dreadful complication of abdominal aortic surgery. Surgical treatment is associated to high mortality and requires urgent graft removal with extra-anatomic or in situ reconstruction. Other authors suggest the use of stent grafts, both as a stand-alone procedure or as a bridge solution before open repair. We reviewed the results of a cohort of patients that presented at our institution with an AEF and were treated with a novel 2-step endovascular-open surgical procedure. The first step consisted in immediate endovascular occlusion of the infrarenal graft with deployment, below the renal arteries, of an aortic occluder and/or endovascular plugs. After occlusion of the infrarenal graft, extra-anatomic reconstruction (axillofemoral bypass) was performed. The second step consisted in the removal of the infrarenal graft with aortic stump ligation and took place after a few days recovery to allow improvement of patients' condition. A total of 5 selected patients were treated. Endovascular aortic occlusion was achieved in all cases with the deployment of 1 (3 patients) or 2 (2 patients) devices. The mean interval between the first and the second step was 7 days (min 4-max 13). Complete removal of the aortic graft was possible in all patients. One patient died on the first postoperative day due to multiorgan failure (1 of 5, 20%). Mean survival after discharge was 24 months (min 6-max 36). One patient died at 6 months because of aortic stump blowout. In our initial experience, endovascular aortic occlusion seems an effective option to prevent fatal enteric bleeding and a valuable first-step treatment for selected cases of AEF.
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57
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Contemporary Management of Secondary Aortoduodenal Fistula. Ann Vasc Surg 2015; 29:1614-8. [DOI: 10.1016/j.avsg.2015.06.090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 06/23/2015] [Accepted: 06/28/2015] [Indexed: 11/20/2022]
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Moulakakis KG, Kakisis J, Dalainas I, Smyrniotis V, Liapis CD. Endovascular management of secondary aortoduodenal fistula: the importance of gut restoration. Int J Angiol 2015; 24:55-8. [PMID: 25780328 DOI: 10.1055/s-0033-1349714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Secondary aortoenteric fistula (SAEF) is a rare, life-threatening complication of aortic reconstructive surgery. Graft excision associated with gut repair and extra-anatomic bypass or in situ aortic reconstruction is the best option. However, it is associated with high mortality rates, especially when undertaken in unstable patients with severe comorbidities. We present a case of SAEF successfully treated by endovascular repair and gut restoration. After laparotomy, a dense inflammatory "frozen" mass was found around the involved part of the duodenum and the aortic sac. Because of his comorbidities, the difficulty in dissection of the aortic sac and the risk of damage in adjacent organs, the initial plan for aortic reconstruction was abandoned. A surgical isolation of the third portion of the duodenum and a duodenum-jejunal anastomosis were performed. An Endurant endograft 32-16-16 mm (Medtronic, Inc., Minneapolis, MN) was implanted to achieve aortic continuity. Twenty months postdischarge, the patient remains in good general condition, afebrile, and with normal laboratory tests and inflammation markers. In high-risk patients, endovascular intervention combined with gut repair without further aortic reconstruction can be a permanent solution requiring, however, close surveillance.
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Affiliation(s)
- Konstantinos G Moulakakis
- Department of Vascular Surgery, Athens University Medical School, "Attikon" University Hospital, Athens, Greece
| | - John Kakisis
- Department of Vascular Surgery, Athens University Medical School, "Attikon" University Hospital, Athens, Greece
| | - Ilias Dalainas
- Department of Vascular Surgery, Athens University Medical School, "Attikon" University Hospital, Athens, Greece
| | - Vasilis Smyrniotis
- 4th Department of Surgery, Athens University, Medical School, "Attikon" University Hospital, Athens, Greece
| | - Christos D Liapis
- Department of Vascular Surgery, Athens University Medical School, "Attikon" University Hospital, Athens, Greece
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60
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Menna D, Capoccia L, Sirignano P, Esposito A, Rossi M, Speziale F. Infective Etiology Affects Outcomes of Late Open Conversion After Failed Endovascular Aneurysm Repair. J Endovasc Ther 2015; 22:110-5. [DOI: 10.1177/1526602814562777] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To retrospectively review all patients undergoing late open conversion (LOC) after endovascular aneurysm repair (EVAR) in order to identify any clinical or technical predictors of poor outcome. Methods: Twenty-six consecutive patients (24 men; mean age 74.7±8.3 years) underwent LOC between June 2006 and April 2013 at our institution. The mean interval from index EVAR to LOC was 40.4±29.2 months (range 5–93 months). The indication for LOC was endoleak in 14 (54%) patients and infection in 12 (46%): 2 (8%) patients with endoleak had a ruptured aneurysm and 6 (23%) patients with infection had a recurrent secondary aortoesophageal fistula (sAEF). Results: In all 12 cases of infection and in 12 of 14 endoleaks, the entire endograft was explanted. A rifampin-soaked Dacron silver graft was implanted in all patients with infection. Patients with any infection and with recurrent AEF required more blood units than patients with endoleak (6.40 vs. 1.86, p=0.045; 6.76 vs. 1.86, p=0.0036, respectively). Compared with endoleak, the duration of conversions in the setting of infection (274 vs. 316 minutes, p=0.42) and recurrent sAEF (274 vs. 396 minutes, p=0.021) was longer. All patients with recurrent sAEF died at a mean 3.0±2.5 days after LOC from proximal anastomosis disruption and hemorrhagic shock (n=2), myocardial infarction (n=2), acute stroke (n=1), or persistent sepsis (n=1). Perioperative mortality was significantly higher in patients with endograft infection (6/12, p=0.002) and in cases of supraceliac cross-clamping (4/6, p=0.003). The association of infection with supraceliac cross-clamping was a strong predictor for perioperative mortality (p<0.001). Conclusion: In our experience, endograft infection led to greater perioperative mortality after LOC. Recurrent aortoenteric fistula in association with supraceliac cross-clamping is a strong predictor of poor outcome. Patients surviving the perioperative period may have good chances of long-term survival.
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61
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Setacci C, Chisci E, Setacci F, Ercolini L, de Donato G, Troisi N, Galzerano G, Michelagnoli S. How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:255-64. [PMID: 26798744 DOI: 10.12945/j.aorta.2014.14-036] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/03/2014] [Indexed: 12/14/2022]
Abstract
The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a correct diagnosis. There is no good evidence to guide management so far. In the case of active gastrointestinal bleeding, pseudoaneurysm, or extensive perigraft purulence involving adjacent organs, an invasive treatment should always be attempted. In the other cases (the majority), when there is not an immediate danger to the patient's life, a conservative management is started with a proper antimicrobial therapy. Any infectious cavity can be percutaneously drained. Management depends on the patient's condition and a tailored approach should always be offered. In the case of a patient who is young, has a good life expectancy, or in whom there is absence of significant comorbidities, a surgical attempt can be proposed. Surgical techniques favor, in terms of mortality, patency, and reinfection rate, the in situ reconstruction. Choice of technique relies on the center and the operator's experience. Long-term antibiotic therapy is always required in all cases, with close monitoring of the C-reactive protein.
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Affiliation(s)
- Carlo Setacci
- Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - Emiliano Chisci
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | - Francesco Setacci
- P. Valdoni Department of Surgery, La Sapienza University, Rome, Italy
| | - Leonardo Ercolini
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | | | - Nicola Troisi
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | - Giuseppe Galzerano
- Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - Stefano Michelagnoli
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
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62
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Tagowski M, Vieweg H, Wissgott C, Andresen R. Aortoenteric fistula as a complication of open reconstruction and endovascular repair of abdominal aorta. Radiol Res Pract 2014; 2014:383159. [PMID: 25302119 PMCID: PMC4180205 DOI: 10.1155/2014/383159] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/05/2014] [Indexed: 11/17/2022] Open
Abstract
The paper intends to present a review of imaging characteristics of secondary aortoenteric fistula (AEF). Mechanical injury, infection, and adherence of a bowel segment to the aorta or aortic graft are major etiologic factors of AEF after open aortic repair. The pathogenesis of AEF formation after endovascular abdominal aortic repair is related to mechanical failure of the stent-graft, to stent graft infection, and to persistent pressurization of the aneurysmal sac. The major clinical manifestations of AEF comprise haematemesis, melaena, abdominal pain, sepsis, and fever. CT is the initial diagnostic modality of choice in a stable patient. However, the majority of reported CT appearances are not specific. In case of equivocal CT scans and clinical suspicion of AEF, scintigraphy, (67)Ga citrate scans or (18)F-FDG PET/CT is useful. Diagnostic accuracy of endoscopy in evaluation of AEF is low; nevertheless it allows to evaluate other than AEF etiologies of gastrointestinal bleeding. Without adequate therapy, AEF is lethal. Conventional surgical treatment is associated with high morbidity and mortality. The endovascular repair may be an option in hemodynamically unstable and high-risk surgical patients. We also illustrate an example of a secondary AEF with highly specific albeit rare radiologic picture from our institution.
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Affiliation(s)
- Marek Tagowski
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Esmarchstraße 50, 25746 Heide, Germany
| | - Hendryk Vieweg
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Esmarchstraße 50, 25746 Heide, Germany
| | - Christian Wissgott
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Esmarchstraße 50, 25746 Heide, Germany
| | - Reimer Andresen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Esmarchstraße 50, 25746 Heide, Germany
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63
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Chen ZJ, Freeman ML. Management of upper gastrointestinal bleeding emergencies: evidence-based medicine and practical considerations. World J Emerg Med 2014; 2:5-12. [PMID: 25214975 DOI: 10.5847/wjem.j.1920-8642.2011.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 01/26/2011] [Indexed: 01/06/2023] Open
Abstract
Acute upper gastrointestinal (GI) bleeding remains one of the most common encounters in emergency medicine. The increased use of non-steroid anti-inflammatory drugs by the general population and the increased prescription of anti-platelet agents and anti-coagulants after cardiovascular interventions and for prevention of cerebral vascular accidents may have aggravated the situation. Significant progress has been made in the past decade or so in the non-surgical management of acute upper GI bleeding emergencies. This article will review the current standard treatment of the most common upper GI bleeding emergencies in adults as supported by evidence-based medicine with practical considerations from the authors' own practice experience.
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Affiliation(s)
- Zongyu John Chen
- Minnesota Gastroenterology PA, Minneapolis, MN 55414 (Chen ZJ); Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical School, Minneapolis, MN 55455 (Freeman ML), USA
| | - Martin L Freeman
- Minnesota Gastroenterology PA, Minneapolis, MN 55414 (Chen ZJ); Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical School, Minneapolis, MN 55455 (Freeman ML), USA
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Martinez Aguilar E, Fernández Alonso S, Santamarta Fariña E, Fernández Alonso L, Atienza Pascual M, Centeno Vallespuga R. Estado actual sobre el diagnóstico y tratamiento de fístulas aortoentéricas. ANGIOLOGIA 2014. [DOI: 10.1016/j.angio.2014.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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65
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Zaki M, Tawfick W, Alawy M, ElKassaby M, Hynes N, Sultan S. Secondary aortoduodenal fistula following endovascular repair of inflammatory abdominal aortic aneurysm due to Streptococcus anginosus infection: A case report and literature review. Int J Surg Case Rep 2014; 5:710-3. [PMID: 25201477 PMCID: PMC4189064 DOI: 10.1016/j.ijscr.2013.10.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 09/18/2013] [Accepted: 10/29/2013] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Aortoenteric fistula is a rare but very serious complication of both surgical and endovascular abdominal aortic reconstruction. Since the advent of endovascular abdominal aortic aneurysm repair (EVAR), 20 cases of aortoduodenal fistula associated with aortic stent grafts have been reported.1 However, only a handful has been reported following inflammatory abdominal aortic aneurysm repair. It most commonly presents with bleeding, usually from the upper gastro-intestinal tract. With recent advances in the screening, diagnosis and management of abdominal aortic aneurysms either surgically or through an endovascular approach, the diagnosis of an aortoduodenal fistula in patients with gastro-intestinal bleeding must be suspected and excluded. PRESENTATION OF CASE We describe a case of secondary aortoduodenal fistula that occurred two and a half years following endovascular stent graft repair of an inflammatory abdominal aortic aneurysm. We also outline the emergency correction plan and the attempts at repair. DISCUSSION This case defies the general concept that patients with inflammatory abdominal aortic aneurysms are relatively immune to rupture. Although the presence of a peri-aneurysm thick inflammatory membrane decreases the possibility of rupture, these patients are more susceptible to other related complications such as aorto-enteric and aorto-caval fistulas.2 This case also demonstrates the peculiar presence of Streptococcus anginosus as the pathological organism leading to graft infection and subsequent fistula, as opposed to enterococci which are often found in endograft infection. CONCLUSION Aorto-enteric fistulas are associated with a grave prognosis. Early diagnosis is crucial and extra vigilance should be taken in cases of inflammatory AAA.
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Affiliation(s)
- M Zaki
- Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Newcastle Road, Galway, Ireland; Department of Vascular Surgery (Unit 7), El-Demerdash Hospital, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
| | - W Tawfick
- Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Newcastle Road, Galway, Ireland.
| | - M Alawy
- Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Newcastle Road, Galway, Ireland; Department of Vascular Surgery (Unit 7), El-Demerdash Hospital, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
| | - M ElKassaby
- Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Newcastle Road, Galway, Ireland.
| | - N Hynes
- Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Newcastle Road, Galway, Ireland; Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Galway, Ireland.
| | - S Sultan
- Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital, Galway (UCHG), Newcastle Road, Galway, Ireland; Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Galway, Ireland.
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Bissacco D, Freni L, Attisani L, Barbetta I, Dallatana R, Settembrini P. Unusual clinical presentation of primary aortoduodenal fistula. Gastroenterol Rep (Oxf) 2014; 3:170-4. [PMID: 24982129 PMCID: PMC4423455 DOI: 10.1093/gastro/gou040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/10/2014] [Indexed: 11/16/2022] Open
Abstract
Primary aorto-enteric fistula (PAEF) develops between the native aorta and the gastro-intestinal tract, in the presence of an abdominal aortic aneurysm. It is a rare, life-threatening condition and appears to be less frequent than secondary aorto-enteric fistula, which is associated with previous aortic prosthetic reconstruction. When untreated, the overall mortality rate is almost 100%. Diagnosis may be challenging until the occurrence of a massive haemorrhage. In the presence of gross contamination, patients tend to a worse prognosis. Extra-anatomical bypass and repair of the enteric tract is the treatment of choice in case of gross contamination. In situ reconstruction is often reported in cases of mild bacterial contamination. Endovascular treatment has recently become a valid option in haemodynamically unstable patients, but a staged approach, with delayed surgical treatment, seems advisable.
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Affiliation(s)
| | - Luca Freni
- Vascular Surgery, Ospedale San Carlo Borromeo, Milan, Italy
| | - Luca Attisani
- Vascular Surgery, Ospedale San Carlo Borromeo, Milan, Italy
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Lai A, Naunton Morgan R, Tan J. Secondary aorto-esophageal fistula managed with endoluminal stenting. ANZ J Surg 2014; 86:619-21. [PMID: 24975595 DOI: 10.1111/ans.12741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alvin Lai
- Department of General Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Richard Naunton Morgan
- Department of General Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Jeremy Tan
- Department of General Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Yu HH, Wong HH, Wong DC, Cheung FK, Yien RL, Li MK. Endovascular treatment for secondary aortoduodenal fistula. SURGICAL PRACTICE 2014. [DOI: 10.1111/1744-1633.12060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Harry H.Y. Yu
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong China
| | - Ho-Hing Wong
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong China
| | - Dennis C.T. Wong
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong China
| | - Frances K.Y. Cheung
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong China
| | - Renny L.C. Yien
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong China
| | - Michael K.W. Li
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong China
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69
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San Norberto E, Brizuela J, Taylor J, Carrera S, Ibáñez M, Vaquero C. Endovascular Treatment is an Accurate Option for Aortoenteric Secondary Fistulae in TASC D Patients. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.ejvsextra.2014.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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70
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Thomas M, Van Loo P, Kamali D, Mofidi R. Emergency Endovascular Management of a Secondary Aorto-enteric Fistula: A Case Report. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.ejvsextra.2013.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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71
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Rodrigues dos Santos C, Casaca R, Mendes de Almeida JC, Mendes-Pedro L. Enteric repair in aortoduodenal fistulas: a forgotten but often lethal player. Ann Vasc Surg 2013; 28:756-62. [PMID: 24456836 DOI: 10.1016/j.avsg.2013.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 05/25/2013] [Accepted: 09/01/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND An aortoenteric fistula is an abnormal communication between the aorta and the bowel lumen. It is usually caused by previous aortic surgery and involves the duodenum (ADF) in most cases. The treatment of this high-mortality condition is based on the correction of enteric and vascular defects. However, enteric repair indications and impact are unknown. OBJECTIVE We sought to characterize the surgical procedures available for duodenal repair in ADF and estimate their impact in mortality. METHODS A literature search was conducted, between the years 1951-2010. Cases (791 from 614 references) were individually registered and analyzed to demography, enteric location, type and cause of fistula, type of surgical procedure, mortality, and cause of death. Risk factors to outcome were estimated by univariate and multivariate analysis. RESULTS The enteric procedure was described in 331 cases: duodenorrhaphy (with or without omentum interposition; with or without enterostomy) in 266 cases, duodenal resection/reconstruction in 54 cases, antibiotic or abdominal drainage alone in 4 cases, and nothing was done in 7 cases. Vascular treatment was described in 515 cases: extra-anatomic bypass in 207 cases, in situ graft in 197 cases, direct closure of the aortic defect in 52 cases, endovascular procedures in 32 cases, and others arterial reconstructions in 27 cases. Univariate analysis revealed that mortality caused by ADF is directly associated with primary ADF type, direct closure of the aortic defect, and is inversely associated with recent publications, omentum interposition, use of an in situ graft, and endovascular prosthesis. Multivariate analysis revealed that omentum interposition and the use of an in situ graft were independent factors to the outcome, and that omentum use was the strongest factor related to survival. The most common cause of death was ADF recurrence (41.8%), which was significantly high (P = 0.036) in the patients who underwent simple duodenorrhaphy. CONCLUSIONS The literature supports the use of omentum interposition and suggests that duodenal derivation is preferable to the simple closure of fistula. Delayed or avoided enteric repair after endovascular treatment emerged as an option, but needs additional supporting research.
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Affiliation(s)
- Catarina Rodrigues dos Santos
- Department of Surgical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Faculdade de Medicina de Lisboa, Lisbon, Portugal.
| | - Rui Casaca
- Department of Surgical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Faculdade de Medicina de Lisboa, Lisbon, Portugal
| | - José Crespo Mendes de Almeida
- Department of Surgical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal; Faculdade de Medicina de Lisboa, Lisbon, Portugal
| | - Luis Mendes-Pedro
- Department of Vascular Surgery, Centro Hospitalar Lisboa Norte, Lisbon, Portugal; Faculdade de Medicina de Lisboa, Lisbon, Portugal
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72
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Sörelius K, Sundbom M, Mani K, Wanhainen A. Hybrid treatment of a post-EVAR aortoenteric fistula. Vascular 2013; 22:385-9. [DOI: 10.1177/1708538113501661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This report presents a case of secondary aortoenteric fistula after endovascular aortic repair in a fragile patient: The fistula developed due to aneurysm shrinkage and remodeling of the stent graft, resulting in a kink eroding through the aneurysm wall into the duodenum. The aortoenteric fistula was successfully treated with a hybrid procedure with endovascular aortic repair, followed by open enteroraphy and omental flap coverage of the stent graft and local antibiotic irrigation. Despite the presence of the stent graft in a previously infected field, the patient has recovered from the acute event with no septic recurrence or hemorrhage during four years of follow-up.
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Affiliation(s)
- Karl Sörelius
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Sweden
| | - Magnus Sundbom
- Section of Upper Abdominal Surgery, Uppsala University, Sweden
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Sweden
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73
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Lyons O, Patel A, Saha P, Clough R, Price N, Taylor P. A 14-year Experience with Aortic Endograft Infection: Management and Results. Eur J Vasc Endovasc Surg 2013; 46:306-13. [DOI: 10.1016/j.ejvs.2013.04.021] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/10/2013] [Indexed: 02/05/2023]
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74
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Fístulas aorto-entéricas secundárias – caso clínico. ANGIOLOGIA E CIRURGIA VASCULAR 2013. [DOI: 10.1016/s1646-706x(13)70018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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75
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Rioja Artal S, Solanich Valldaura T, Peñas Juárez C, Barriuso Babot D, Giménez Gaibar A. Tratamiento endovascular de las fístulas aortoentéricas secundarias. ANGIOLOGIA 2013. [DOI: 10.1016/s0003-3170(13)70077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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76
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Perencevich M, Saltzman JR, Levy BD, Loscalzo J. Clinical problem-solving. The search is on. N Engl J Med 2013; 368:562-7. [PMID: 23388008 DOI: 10.1056/nejmcps1200126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Molly Perencevich
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
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77
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Rossi FH, Izukawa NM, Prakasan AK, Barbato HA, Kambara A, Metzger PB, Linhares Filho FADC, Betelli CB. Relato de caso de tratamento endovascular de fístula aorto-entérica secundária. J Vasc Bras 2012. [DOI: 10.1590/s1677-54492012000300012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O tratamento tradicional da fístula aorto-entérica secundária baseia-se na retirada cirúrgica da prótese, desbridamento aórtico, enxerto extra-anatômico, ou in situ, nos casos em que o campo cirúrgico apresenta-se sem sinais de infecção. Recentemente, alguns autores vêm preconizando o tratamento endovascular em pacientes instáveis e com alto risco cirúrgico. Apresentamos um relato de caso de paciente portador de fístula aorto-entérica secundária tratado inicialmente por via endovascular.
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Affiliation(s)
| | | | | | | | - Antonio Kambara
- Instituto Dante Pazzanese de Cardiologia, Brasil; Colégio Brasileiro de Radiologia, Brasil
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78
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Serie de casos. Experiencia de un único centro en el tratamiento de fístulas aortoentéricas. ANGIOLOGIA 2012. [DOI: 10.1016/j.angio.2012.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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79
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Genovés-Gascó B, Torres-Blanco Á, Plaza-Martínez Á, Olmos-Sánchez D, Gómez-Palonés F, Ortiz-Monzón E. Primary aortoduodenal fistula in a patient with pararenal abdominal aortic aneurysm. Ann Vasc Surg 2012; 26:730.e1-5. [PMID: 22503432 DOI: 10.1016/j.avsg.2011.11.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 07/13/2011] [Accepted: 11/04/2011] [Indexed: 11/15/2022]
Abstract
Primary aortoenteric fistula is a rare and extremely serious condition. In most cases, it is caused by an abdominal aortic aneurysm presenting with symptoms of gastrointestinal bleeding. Diagnosis is difficult owing to its rarity and the fact that diagnostic tests are not definitive in many cases. Surgery is performed urgently in most cases and is associated with high mortality. We report a case of a 65-year-old man presenting with symptoms of abdominal pain and massive rectal hemorrhage. Computed tomography revealed a pararenal abdominal aortic aneurysm and suspected aortoenteric fistula. The patient underwent an emergency surgery, confirming the suspected diagnosis. The surgery performed was the traditionally recommended extra-anatomical bypass with aortic ligation and repair of the intestinal defect. We describe the clinical condition and provide an up-to-date overview of diagnosis and treatment by reviewing the literature. We believe the therapeutic decision should be personalized by assessing the anatomy of the aneurysm, the patient's clinical status, the degree of local contamination, and the surgeon's experience with each of the techniques.
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Affiliation(s)
- Beatriz Genovés-Gascó
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario Dr. Peset, Valencia, España.
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80
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Tan GWL, Wong D, Punamiya S, Tan BP, Vu C, Ang B, Foo D, Chia KH. Aortoenteric Fistula Treated With Endovascular Aortic Stent-Graft and Bilateral Chimney Stent-Grafts to Renal Arteries. Ann Vasc Surg 2012; 26:422.e13-6. [DOI: 10.1016/j.avsg.2011.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 07/12/2011] [Accepted: 07/15/2011] [Indexed: 11/26/2022]
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81
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82
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Singh S, Ladabaum U, Hovsepian DM, Triadafilopoulos G. Cancer-associated aorto-enteric fistula. Dig Dis Sci 2012; 57:625-9. [PMID: 22021052 DOI: 10.1007/s10620-011-1945-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 10/08/2011] [Indexed: 12/09/2022]
Affiliation(s)
- Sundeep Singh
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, Always Building M211, Stanford, CA 94305, USA.
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83
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Malgor RD, Oderich GS, Andrews JC, McKusick M, Kalra M, Misra S, Gloviczki P, Bower TC. Evolution from open surgical to endovascular treatment of ureteral-iliac artery fistula. J Vasc Surg 2012; 55:1072-80. [PMID: 22326578 DOI: 10.1016/j.jvs.2011.11.043] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 11/03/2011] [Accepted: 11/03/2011] [Indexed: 02/03/2023]
Abstract
PURPOSE To review the indications and results of open surgical and endovascular treatment for ureteral-iliac artery fistula (UIAF). METHODS We reviewed the clinical data of 20 consecutive patients treated for 21 UIAFs between 1996 and 2010. Since 2004, iliac artery stent grafts were the primary treatment except for complex fistulas with enteric contamination or abscess. Endpoints were early morbidity and mortality, patient survival, vessel or graft patency, freedom from vascular or stent graft/graft infection, and freedom from recurrent bleeding. RESULTS There were 20 patients, 15 females, and five males, with mean age of 63 ±13 years. Predisposing factors for UIAF were prior tumor resection in 18 patients, radiation in 15, ureteral stents in 15, ileal conduits in four, and ileofemoral grafts in three. All patients presented with hematuria, which was massive in 10. Treatment included iliac stent grafts in 11 patients/12 fistulas (55%), with internal iliac artery (IAA) exclusion in nine, femoral crossover graft with IAA exclusion in five, direct arterial repair in three, and ureteral exclusion with percutaneous nephrostomy and no arterial repair in one. There were no early deaths. Five of eight patients treated by open surgical repair developed complications, which included enterocutaneous fistula in three and superficial wound infection in two. Four patients (36%) treated by iliac stent grafts had complications, including pneumonia, non-ST segment elevation myocardial infarction, buttock claudication, and early stent occlusion in one each. After a median follow-up of 26 months, no one had recurrent massive hematuria, but minor bleeding was reported in three. Patient survival at 5 years was 42% compared with 93% for the general population (P < .001). Freedom from any recurrent bleeding at 3 years was 76%. In the stent graft group, primary and secondary patency rates and freedom from stent graft infection at 3 years were 81%, 92%, and 100%. CONCLUSIONS UIAF is a rare complication associated with prior tumor resection, radiation, and indwelling ureteral stents. In select patients without enteric communication or abscess, iliac artery stent grafts are safe and effective treatment, and carry a low risk of recurrent massive hematuria or stent graft infection on early follow-up. Direct surgical repair carries a high risk of enterocutaneous fistula.
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Affiliation(s)
- Rafael D Malgor
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
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84
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Solomon B, Kim B, Rockman C, Veith FJ, Jacobowitz G. Aortic Endograft Infection With Aortoduodenal Fistula Associated With Adjacent Vertebral Body Mycobacterial Osteomyelitis (Pott's Disease). Ann Vasc Surg 2012; 26:276.e1-4. [DOI: 10.1016/j.avsg.2011.05.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 05/17/2011] [Accepted: 05/30/2011] [Indexed: 11/26/2022]
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85
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Song EM, Shim KN, Kang HW, Kwon KJ, Choi JY, Kim SE, Jung HK, Jung SA. A Case of Primary Aortoenteric Fistula Mimicking Duodenal Subepithelial Tumor. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2012. [DOI: 10.7704/kjhugr.2012.12.1.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Eun Mi Song
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hye Won Kang
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyoung Joo Kwon
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ju Young Choi
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Seong-Eun Kim
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hye-Kyung Jung
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung-Ae Jung
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
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86
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87
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Hicks TD, Kedora JC, Shutze WP. Treatment of an ilioenteric fistula with an Amplatzer Vascular Plug. J Vasc Surg 2011; 54:1495-7. [DOI: 10.1016/j.jvs.2011.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 04/29/2011] [Accepted: 05/02/2011] [Indexed: 11/17/2022]
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88
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Pérez SC, Galán FC, Mallagray EP, Grau JB, Marco CF. Endovascular treatment of two aortoduodenal fistulae. Vascular 2011; 19:277-81. [DOI: 10.1258/vasc.2011.cr0268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report the endovascular treatment of two patients presenting with aortoduodenal fistulae. The first patient was a 66-year-old man admitted with hematemesis. He was on clopidogrel and had received a cryopreserved aortic graft for a mycotic abdominal aortic aneurysm five years earlier. Computed tomography (CT) showed aortic pseudoaneurysms in close contact with the duodenum. Endovascular repair was carried out. Twenty-seven months after the procedure the patient remains asymptomatic. The second patient was a 78-year-old man admitted with abdominal pain and nausea. CT revealed an abdominal aortic pseudoaneurysm and aortoduodenal fistula. He suffered from severe chronic obstructive pulmonary disease that greatly increased his surgical morbidity and mortality. An endovascular repair was performed under epidural anesthesia. The patient died of a postoperative pneumonia 38 days after surgery. These two cases illustrate the importance of endovascular aortic repair especially when an open surgical procedure is either difficult or impossible.
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Affiliation(s)
- Susana Cancer Pérez
- Department of Vascular Surgery, Hospital Universitario Fundación Alcorcón, C/ Budapest 1, Alcorcón, Madrid, Spain
| | - Fernando Criado Galán
- Department of Vascular Surgery, Hospital Universitario Fundación Alcorcón, C/ Budapest 1, Alcorcón, Madrid, Spain
| | - Enrique Puras Mallagray
- Department of Vascular Surgery, Hospital Universitario Fundación Alcorcón, C/ Budapest 1, Alcorcón, Madrid, Spain
| | - Juan B Grau
- The University of Pennsylvania School of Medicine, 51 N 39th Street, Suite 2A, Philadelphia, PA 19014, USA
| | - Carmen Fiuza Marco
- Department of General Surgery, Hospital Universitario Fundación Alcorcón, C/ Budapest 1, Alcorcón, Madrid, Spain
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89
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Late outcome following open surgical management of secondary aortoenteric fistula. Langenbecks Arch Surg 2011; 396:1221-9. [DOI: 10.1007/s00423-011-0807-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
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90
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Nolz R, Gschwendtner M, Jülg G, Plank C, Beitzke D, Teufelsbauer H, Wibmer A, Kretschmer G, Lammer J, Schoder M. Anastomotic pseudoaneurysms after surgical reconstruction: outcomes after endovascular repair of symptomatic versus asymptomatic patients. Eur J Radiol 2011; 81:1589-94. [PMID: 21536397 DOI: 10.1016/j.ejrad.2011.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 04/01/2011] [Accepted: 04/06/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare perioperative and follow-up outcomes of symptomatic versus asymptomatic patients following endovascular repair of anastomotic pseudoaneurysms (APAs) of the abdominal aorta and iliac arteries. METHODS We retrospectively evaluated 17 patients (two women), with a mean age of 66.2 years (range 30-83 years). Endovascular treatment was performed in ten symptomatic, and seven asymptomatic patients electively. Data included technical success, perioperative (within 30 days) mortality and morbidity, as well as stent graft-related complications, reinterventions, and survival in follow-up. RESULTS Bifurcated (n = 13), aortomonoiliac (n = 3) endoprosthesis and one aortic cuff were implanted with a primary technical success rate of 100%. The overall in-hospital mortality and morbidity rate was 11.8% and 35.3%. The mean survival was 36.5 (range 0-111) months. There was a clear trend toward a lower overall survival within hospital and at one and three years for symptomatic patients compared to asymptomatic patients. (47.7 (CI: 0-138.8) versus 52.6 (CI: 28.5-76.8) months (p = 0.274)). During follow-up, late stent graft related complications were observed in six patients (35.3%) necessitating eight endovascular reinterventions. Additional three patients with primary fistulas between the APA and the intestine were treated by late surgical revision. CONCLUSION Endovascular therapy of APAs represents a considerable alternative to open surgical repair. Short proximal anchoring zones still pose a risk for endoleaks and unintentional overstenting of side branches with commercially available devices, but this might be overcome by use of fenestrated and branched stent grafts in elective cases.
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Affiliation(s)
- Richard Nolz
- Department of Radiology, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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91
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Open or Endovascular Repair of Secondary Aortoenteric Fistulae? Eur J Vasc Endovasc Surg 2011; 41:635-6. [DOI: 10.1016/j.ejvs.2011.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 11/20/2022]
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92
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Rivera R, Shah A, Ozden N. Iliac-enteric fistula diagnosed by video capsule endoscopy. Clin Gastroenterol Hepatol 2011; 9:e39-40. [PMID: 21145420 DOI: 10.1016/j.cgh.2010.11.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 11/02/2010] [Accepted: 11/07/2010] [Indexed: 02/07/2023]
Affiliation(s)
- Rene Rivera
- University of Rochester Medical Center, Rochester, New York, USA
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93
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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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94
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La Greca G, Barbagallo F, Gagliardo S, Latteri S, Scala V, Sofia M, Russello D. Fistule aorto-duodénale récidivante. ANNALES DE CHIRURGIE VASCULAIRE 2011; 25:413.e7-413.e11. [DOI: 10.1016/j.acvfr.2012.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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95
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La Greca G, Barbagallo F, Gagliardo S, Latteri S, Scala V, Sofia M, Russello D. Recurrent Aortoduodenal Fistula. Ann Vasc Surg 2011; 25:386.e7-386.e11. [DOI: 10.1016/j.avsg.2010.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 11/09/2010] [Accepted: 11/11/2010] [Indexed: 11/26/2022]
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96
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Abstract
A infecção envolvendo endopróteses é uma complicação pouco frequente, associada a elevadas taxas de mortalidade. A apresentação clínica é geralmente tardia, podendo variar de sintomas inespecíficos até complicações graves como pseudoaneurisma e fístula aortoentérica. O diagnóstico envolve alto índice de suspeição e investigação com exames de imagem e laboratoriais. O tratamento segue os preceitos da infecção de prótese em cirurgia convencional, indicando-se, para a maioria dos pacientes, a excisão cirúrgica acompanhada da revascularização in situ ou extra-anatômica. O tratamento conservador fica reservado para casos selecionados.
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97
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Endovascular Repair of a Secondary Aorto-Appendiceal Fistula. Cardiovasc Intervent Radiol 2011; 34:1090-3. [DOI: 10.1007/s00270-011-0121-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 01/24/2011] [Indexed: 11/27/2022]
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98
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Kakkos SK, Papadoulas S, Tsolakis IA. Endovascular management of arterioenteric fistulas: a systemic review and meta-analysis of the literature. J Endovasc Ther 2011; 18:66-77. [PMID: 21314352 DOI: 10.1583/10-3229.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To present a systemic review and meta-analysis investigating the outcomes of endovascular management of arterioenteric fistula (AEF). METHODS Literature review on AEF management with endovascular surgery using MEDLINE search, including two cases managed by the authors. RESULTS Fifty-nine patients (50 men; mean age 68 years, range 23-90) were identified. AEF was successfully managed in 55 (93%) patients and 30-day mortality was 8.5% (5/59). During follow-up, 10 (19%) patients developed recurrent bleeding, which occurred more often in AEFs due to cancer. The freedom from recurrence rate at 12 and 24 months was 71.5%. Seventeen (32%) patients developed sepsis, which was managed conservatively in 8 (7 successful). Freedom from sepsis at 12 and 24 months was 64%, while the freedom from combined recurrence and sepsis at 12 and 24 months was 59%. Patients who did not have intestinal repair had a higher rate of combined recurrence and sepsis compared to patients who did; the freedom from combined recurrence and sepsis at 12 months was 52% for patients not having intestinal repair versus 100% in patients who did (p = 0.022). Total AEF-related mortality rates at 12 and 24 months were 15% and 19%, respectively, significantly worse when AEF recurred (p = 0.001). Overall survival rates at 12 and 24 months were 68% and 52%; prognosis was worse in patients with perioperative sepsis, large bowel fistulization, tube graft placement, no intestinal repair, and recurrent AEF. CONCLUSION Endovascular management of AEF can achieve satisfactory short and midterm results, better than those historically reported for open surgery, despite the high rate of recurrent bleeding and sepsis. Further investigation of the role played by intestinal repair is warranted.
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Affiliation(s)
- Stavros K Kakkos
- Department of Vascular Surgery, University Hospital of Patras, Rio, Patras Greece.
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Oderich GS, Bower TC, Hofer J, Kalra M, Duncan AA, Wilson JW, Cha S, Gloviczki P. In situ rifampin-soaked grafts with omental coverage and antibiotic suppression are durable with low reinfection rates in patients with aortic graft enteric erosion or fistula. J Vasc Surg 2011; 53:99-106, 107.e1-7; discussion 106-7. [DOI: 10.1016/j.jvs.2010.08.018] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 08/05/2010] [Accepted: 08/06/2010] [Indexed: 12/20/2022]
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