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A systematic review of the surgical management of secondary aortoduodenal fistula. J Vasc Surg 2022; 77:1562-1568.e4. [PMID: 36343874 DOI: 10.1016/j.jvs.2022.10.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Secondary aortoduodenal fistulae (SADF) are uncommon but life-threatening conditions that occur as complications of aortic reconstructive surgery. Data on the mortality and morbidity of procedures associated with SADF remain scarce. METHODS Comprehensive literature search was conducted on the MedLine, Scopus, Embase, and Web of Knowledge databases for cases of SADF. Data regarding patient demographics, fistula anatomy and treatment interventions performed were extracted for further analysis. RESULTS The study pool consisted of 127 case reports, 28 case series and 1 retrospective study published between 1973 and 2021. A total of 189 patients were operated for SADF. Among the 189 patients, 141 patients (74.6%) had aortic graft excision, 26 (13.8%) aortic primary repair, and 22 (11.6%) EVAR. Although patients undergoing EVAR were older with higher Charlson Comorbidity Index, compared with patients who had graft excision and primary aortic repair these differences were not statistically significant (P = .12 and P = .22, respectively). Primary bowel repair was performed in 145 patients (76.7%), duodenectomy in 25 (13.2%), and no bowel repair in 19 (10.1%). Additional omentoplasty was performed in 65 patients (34.6%). Mortality was comparable with respect to the type of aortic and bowel repair, with no statistically significant differences recorded (P = .54 and P = .77, respectively). Omentoplasty significantly decreased the risk of death (odds ratio, 0.4; 95% confidence interval, 0.2-0.8, P = .01). CONCLUSIONS Optimal operative management should address both the aortic and duodenal defects and be complemented with appropriate reconstructive procedures. Endovascular aortic approaches seem feasible in carefully select patients in whom duodenal repair may be omitted.
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St. Stoyanov G, Dzhenkov D, Petkova L. Primary aortoduodenal fistula: a rare cause of massive gastrointestinal hemorrhage. Autops Case Rep 2021; 11:e2021301. [PMID: 34458170 PMCID: PMC8387084 DOI: 10.4322/acr.2021.301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/04/2021] [Indexed: 01/16/2023]
Abstract
Aortoduodenal fistula (ADF) is the most common type of aortoenteric fistula (AEF). This is a rare entity, which produces communication between an abdominal aortic aneurysm (AAA) and the gastrointestinal tract (GIT), resulting in massive gastrointestinal bleeding. AEF/ADF is difficult to recognize clinically, with the classical triad of symptoms including a pulsating, palpable mass, abdominal pain, and GIT bleeding. AEF/ADF can be classified into primary when a communication between an AAA and the GIT develops with no history of prior aortic reconstructive surgery, and secondary, where the communication is on the background of previous aortic reconstructive surgery. Herein we present a case report of a 75-year-old Caucasian male patient with a clinical history of AAA, who presented with massive GIT bleeding and expired shortly after. An autopsy revealed communication between an atherosclerotic AAA and the lower third of the duodenum.
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Affiliation(s)
- George St. Stoyanov
- Medical University of Varna “Prof. Dr. Paraskev Stoyanov”, Faculty of Medicine, Department of General and Clinical Pathology, Forensic Medicine and Deontology, Varna, Bulgaria
| | - Deyan Dzhenkov
- Medical University of Varna “Prof. Dr. Paraskev Stoyanov”, Faculty of Medicine, Department of General and Clinical Pathology, Forensic Medicine and Deontology, Varna, Bulgaria
| | - Lilyana Petkova
- Medical University of Varna “Prof. Dr. Paraskev Stoyanov”, Faculty of Medicine, Department of General and Clinical Pathology, Forensic Medicine and Deontology, Varna, Bulgaria
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Aortoenteric Fistula after Endovascular Aneurysm Repair. Case Rep Vasc Med 2021; 2021:8828838. [PMID: 33680531 PMCID: PMC7906801 DOI: 10.1155/2021/8828838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022] Open
Abstract
Aortoenteric fistula is a rare complication following endovascular abdominal aortic aneurysm repair. However, there is a significant morbidity and mortality associated with this complication. Patients can present with gastrointestinal hemorrhage, fever, or nonspecific features of chronic infection. Extra anatomic bypass with complete graft explanation is the standard management.
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4
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Aortoduodenal fistulas after endovascular abdominal aortic aneurysm repair and open aortic repair. J Vasc Surg 2021; 74:711-719.e1. [PMID: 33684467 DOI: 10.1016/j.jvs.2021.02.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/11/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In the present study, we have reported and compared aortoduodenal fistulas (ADFs) after endovascular abdominal aortic aneurysm repair (EVAR) vs after open aortic repair (OAR). METHODS We retrospectively analyzed the data from patients treated for ADFs from January 2015 to May 2020 in our hospital. The clinical data, diagnostic procedures, and surgical options were evaluated. The primary endpoints of the present study were 30-day and 1-year mortality. The secondary endpoints were major postoperative complications. RESULTS A total of 24 patients (20 men; median age, 69 years; range, 53-82 years) were admitted with ADFs after EVAR (n = 9) or OAR (n = 15). These patients accounted for ∼4.3% of all abdominal aortic aneurysm repairs in our hospital. The median interval from the initial aortic repair and the diagnosis of ADF was 68 months (range, 6-83 months) for the ADF-EVAR group and 80 months (range, 1-479 months) for the ADF-OAR group. Three patients in the ADF-EVAR group had refused surgical treatment owing to their high surgical risk. One patient in the ADF-OAR group had undergone removal of the aortic prosthesis without replacement. Of the remaining 20 patients, 12 (ADF-EVAR group, n = 4; ADF-OAR group, n = 8) had undergone in situ replacement of the aorta and 8 (ADF-EVAR group, n = 2; ADF-OAR group, n = 6) had undergone extra-anatomic reconstruction with aortic ligation. After a mean follow-up of 26 months, no patient had experienced early limb loss. However, one case of rupture of the venous graft (ADF-EVAR), one case of aortic stump blowout (ADF-OAR), and one case of a ureteroarterial fistula with a homograft (ADF-OAR) had occurred. Overall, the incidence of postoperative complications was significantly greater after ADF-OAR (93% vs 33%; P = .036). The most frequent bacteria involved in the blood cultures were Escherichia coli (25% of patients), and Candida spp. (61%) were the predominant pathogens found on intra-abdominal smears. The in-hospital mortality rates for the ADF-EVAR and ADF-OAR group were 22% and 13%, respectively. The corresponding 1 -year mortality rates were 22% and 33%. CONCLUSIONS Patients with ADFs after EVAR or OAR have limited overall survival. In addition to the similar therapeutic approaches, we found no significant differences in postoperative mortality between these two uncommon pathologic entities. In our study, the overall postoperative morbidity seemed greater for the ADF-OAR group.
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Boisvert A, Gilbert N, Hivon P, Rheaume P. Q fever aortic infection causing an aortoduodenal fistula after endovascular aneurysm repair. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:487-489. [PMID: 33134625 PMCID: PMC7588805 DOI: 10.1016/j.jvscit.2020.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/12/2020] [Indexed: 11/18/2022]
Abstract
An aortoduodenal fistula is a rare complication of endovascular aortic aneurysm repair. Q fever infection is known for its vascular tropism, and arterial fistulas have been reported in association with Coxiella burnetii infections. We report the case of a 78-year-old patient who had developed an aortoduodenal fistula secondary to vascular Q fever 5 years after he had been treated with an aortic endograft. Explantation of the endograft, autogenous reconstruction using the neo-aortoiliac system procedure, and duodenal repair were performed as a curative surgical treatment of this serious vascular condition. At the 9-month follow-up examination, the patient showed no signs of recurrent vascular infection and was instructed to complete an 18-month antibiotic regimen.
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Affiliation(s)
- Annie Boisvert
- Division of Vascular Surgery, CHU de Québec, Quebec City, Quebec, Canada
- Correspondence: Annie Boisvert, MD, MSc, Division of Vascular Surgery, CHU de Quebec, 10 rue d’Espinay, Quebec City, Quebec G1L 3L5, Canada
| | - Nathalie Gilbert
- Division of Vascular Surgery, CHU de Québec, Quebec City, Quebec, Canada
| | - Pierre Hivon
- Division of Infectious Diseases and Microbiology, CHU de Québec, Quebec City, Quebec, Canada
| | - Pascal Rheaume
- Division of Vascular Surgery, CHU de Québec, Quebec City, Quebec, Canada
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Joshi G, Ogbudinkpa C, Stecher J, Khoury RE, Resnick DJ, Jacobs CE, White JV, Schwartz LB. Treatment of Post-Evar Aortoduodenal Fistula Without Endograft Excision. Vasc Endovascular Surg 2020; 55:282-285. [PMID: 33047669 DOI: 10.1177/1538574420966455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
An 80 year-old gentleman presented with aortoduodenal fistula 2 months after uncomplicated endovascular aneurysm repair (EVAR). Upon laparotomy and fistula takedown, there was no active hemorrhage from the excluded aneurysm. It was theorized the fistula had originated from an occult type II endoleak which had since thrombosed. The duodenum was repaired primarily; the anterior defect in the aneurysm sac was packed and covered with omentum. The patient recovered uneventfully and remains well after 9 months. This is the first case, to our knowledge, of a post-EVAR aortoduodenal fistula successfully treated without endograft excision.
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Affiliation(s)
- Gaurang Joshi
- Department of Surgery, 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Chinelo Ogbudinkpa
- Department of Surgery, 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Johanna Stecher
- Department of Surgery, 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Rym El Khoury
- Department of Surgery, 8785University of California San Francisco, San Francisco, CA, USA
| | - Daniel J Resnick
- Department of Surgery, 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Chad E Jacobs
- Department of Surgery, 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - John V White
- Department of Surgery, 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Lewis B Schwartz
- Department of Surgery, 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
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Hosaka A, Nemoto M, Motoki M, Akai A, Kato M. Aortoduodenal Fistula After Endovascular Abdominal Aortic Aneurysm Repair. Vasc Endovascular Surg 2020; 54:445-448. [DOI: 10.1177/1538574420918969] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Aortoduodenal fistula after endovascular treatment of abdominal aortic aneurysm is a very rare but life-threatening complication. Herein, we describe 4 cases of aortoduodenal fistula diagnosed at 15 to 78 months after the index aortic intervention, all successfully treated by surgery. All patients underwent primary repair of the duodenal wall, creation of tube duodenostomy, stent graft removal, and in situ reconstruction using a rifampicin-soaked prosthesis. Patients received prolonged antibiotic treatment for at least 2 months postoperatively, and all were free of recurrent infection at follow-up. Prompt and appropriate surgical intervention is required to effectively manage this condition.
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Affiliation(s)
- Akihiro Hosaka
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu-shi, Tokyo, Japan
| | - Masaru Nemoto
- Department of Surgery, Ibaraki Prefectural Central Hospital & Cancer Center, Kasama, Ibaraki, Japan
| | - Manabu Motoki
- Department of Cardiovascular Surgery, Morinomiya Hospital, Joto-ku, Osaka, Japan
| | - Atsushi Akai
- Department of Cardiovascular Surgery, Morinomiya Hospital, Joto-ku, Osaka, Japan
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital, Joto-ku, Osaka, Japan
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Makimoto S, Takami T, Shintani H, Kataoka N, Yamaguchi T, Tomita M, Shono Y, Kuroyanagi S. Cases of two patients with aortoduodenal fistula who underwent emergency operation. Int J Surg Case Rep 2020; 69:87-91. [PMID: 32305028 PMCID: PMC7163285 DOI: 10.1016/j.ijscr.2020.03.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/14/2020] [Accepted: 03/19/2020] [Indexed: 01/11/2023] Open
Abstract
Aortoduodenal fistula is a rare cause of gastrointestinal bleeding. However, it is life threatening. Diagnosis requires a high level of clinical suspicion, and surgery can offer the best chance of survival. Primary aortoduodenal fistula is often caused by aortic aneurysm without any previous vascular intervention. Secondary aortoduodenal fistula occurs after surgical treatment for abdominal aortic aneurysm.
Introduction Aortoduodenal fistula (ADF) is a rare but life-threating condition, and it is an important cause of massive gastrointestinal bleeding. Primary ADF often occurs as a result of aortic aneurysm, and secondary ADF develops after the placement of aortic prosthetic graft. Presentation of cases Case 1: A 64-year-old man with hematemesis was transferred to our hospital. The patient was diagnosed with primary ADF. Thus, we performed prosthetic graft replacement for an aortic aneurysm, and suturing of the duodenal fistula and duodenojejunal side-to-side anastomosis were performed. He was then discharged on the 35th postoperative day. After 2 years and 10 months, he died of other diseases. Case 2: A 76-year-old man with a history of abdominal aortic aneurysm repair with a prosthetic graft 5 years back who presented with hematemesis and melena was transferred to our hospital. The patient was diagnosed with secondary ADF, and an emergency endovascular aneurysm repair (EVAR) and suturing of the duodenal fistula were perfomed. He was transferred for rehabilitation purposes on the 108th postoperative day but eventually died of pneumonia 6 months after surgery. Discussion ADF is associated with high mortality. Initial bleeding is usually minor and often intermittent. However, it leads to severe bleeding and hemorrhagic shock. EVAR is preferred over open surgery because it can be performed faster and is less invasive. Recently, in case of hemorrhagic shock, EVAR is used as first-line treatment. Conclusion Accurate diagnosis and immediate treatment are important for the survival of patients with ADF.
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Affiliation(s)
- Shinichiro Makimoto
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan.
| | - Tomoya Takami
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan
| | - Hiroshi Shintani
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan
| | - Naoki Kataoka
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan
| | - Tomoyuki Yamaguchi
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan
| | - Masafumi Tomita
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan
| | - Yoshiharu Shono
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan
| | - Satoshi Kuroyanagi
- Department of Cardiovascular Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan
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Arima D, Suematsu Y, Kurahashi K, Shimizu T, Nishi S, Yoshimoto A. Recurrence of Aortoenteric Fistula after Endovascular Aortic Repair. Ann Vasc Dis 2020; 13:90-92. [PMID: 32273930 PMCID: PMC7140165 DOI: 10.3400/avd.cr.19-00106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aortoenteric fistula (AEF) after endovascular aortic repair (EVAR) is a rare complication, with only 32 cases reported previously. A 71-year-old man who presented with severe duodenal bleeding due to primary AEF (PAEF) underwent successful EVAR. Four years later, the AEF recurred because of dilatation of the aneurysm sac. He underwent emergent surgery, removal of the stent graft, and replacement of an artificial bifurcated graft with placement of a greater omental flap. EVAR for PAEF was an effective option for acute treatment, but it caused refistulization in the long term. EVAR should be considered as a bridge therapy to definitive surgery.
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Affiliation(s)
- Daisuke Arima
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Yoshihiro Suematsu
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Kanan Kurahashi
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Takaharu Shimizu
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Satoshi Nishi
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Akihiro Yoshimoto
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
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Nguyen CL, Lindsay A, McLachlan R, Islam S, Qasabian R, Loa J. Aortoduodenal fistula 2 years after elective endovascular repair of an abdominal aortic aneurysm. ANZ J Surg 2020; 90:2374-2376. [DOI: 10.1111/ans.15773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/27/2020] [Accepted: 01/31/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Chu Luan Nguyen
- Vascular Surgery Department Royal Prince Alfred Hospital Sydney New South Wales Australia
- Surgery Department The University of Sydney Sydney New South Wales Australia
| | - Andrew Lindsay
- Surgery Department The University of Sydney Sydney New South Wales Australia
| | - Rohan McLachlan
- Vascular Surgery Department Royal Prince Alfred Hospital Sydney New South Wales Australia
- Surgery Department University of New South Wales Sydney New South Wales Australia
| | - Samiul Islam
- Vascular Surgery Department Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Raffi Qasabian
- Vascular Surgery Department Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Jacky Loa
- Vascular Surgery Department Royal Prince Alfred Hospital Sydney New South Wales Australia
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De Carvalho H, Javaudin F, Le Conte P. Fistule aortoentérique compliquant une allogreffe aortique. ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2019-0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Koda Y, Murakami H, Yoshida M, Matsuda H, Mukohara N. Secondary Aorto-enteric Fistula and Type II Endoleak Five Years after Endovascular Abdominal Aortic Aneurysm Repair. EJVES Short Rep 2019; 43:12-17. [PMID: 31193640 PMCID: PMC6536776 DOI: 10.1016/j.ejvssr.2019.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/27/2019] [Accepted: 04/14/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction Secondary aorto-enteric fistula (AEF) after endovascular abdominal aortic aneurysm repair (EVAR) is a rare but potentially fatal disease. The aetiology and mechanisms are unclear. This study presents a patient who developed secondary AEF and type II endoleak five years after EVAR. Case A 73 year old man underwent successful EVAR with a bifurcated aortic stent graft for a 5.5 cm infrarenal abdominal aortic aneurysm. The aneurysm sac showed no change in size for three years, then shrank 20 mm to 3.5 cm by five years. After five years and eight months, the patient presented with fever and back pain. Enhanced CT demonstrated enlargement of the aneurysm sac, type II endoleak from the third and fourth right lumbar arteries, and air around the stent graft. An emergency operation was performed. The infected stent graft was removed by pushing up the stent graft to release the hooks from the wall of the aorta. A small fistula resembling a fish mouth measuring 1×1 cm was observed in the third part of the duodenum. The fistula was closed by direct suture, and in situ reconstruction was performed with an 18×9 mm standard polyethylene terephthalate graft. Culture of the explanted stent graft grew enterobacter. Intravenous antibiotic therapy was continued for six weeks and was stopped after confirming no recurrence of infection with computed tomography and laboratory testing. Two years later, there has been no recurrence of infection. Conclusion Long term surveillance is critical because AEF can occur even after initially successful EVAR. Secondary aorto-enteric fistula post endovascular abdominal aortic aneurysm repair can occur in the late phase of follow up. Staged omentopexy may be beneficial for prevention of recurrent infection. Type II endoleak can affect the development of secondary aorto-enteric fistula.
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Affiliation(s)
- Yojiro Koda
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Hospital, Hyogo, Japan
| | - Hirohisa Murakami
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Centre, Himeji, Japan
| | - Masato Yoshida
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Centre, Himeji, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Nobuhiko Mukohara
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Centre, Himeji, Japan
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Spanos K, Kouvelos G, Karathanos C, Matsagkas M, Giannoukas AD. Current status of endovascular treatment of aortoenteric fistula. Semin Vasc Surg 2017; 30:80-84. [PMID: 29248124 DOI: 10.1053/j.semvascsurg.2017.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Aortoenteric fistula (AEF) is one of the most challenging diagnostic and therapeutic entities in vascular surgery. AEF can occur either primarily involving the aorta and the gastrointestinal tract or, more commonly, secondary to previous aortic reconstructive surgery. Traditionally, the treatment of AEF includes graft excision and extra-anatomic bypass surgery or in situ graft replacement. However, recently endovascular repair has emerged as an alternative therapeutic option. In this article, we present published and current evidence for endovascular repair of primary and secondary AEF. When endovascular treatment is applied where appropriate, early outcomes seem to be superior compared to open surgery. This benefit may be lost during long-term follow-up, implying that a staged approach with early conversion to in situ grafting may realize the best patient survival and morbidity. Lifelong administration of antibiotics is associated with a reduction in re-infection. An endovascular approach used as a bridging procedure in unstable patients is recommended, followed by definitive open therapy, if feasible, in patients with good life expectancy.
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Affiliation(s)
- Konstantinos Spanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41334 Larissa, Greece
| | - George Kouvelos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41334 Larissa, Greece
| | - Christos Karathanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41334 Larissa, Greece
| | - Miltiadis Matsagkas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41334 Larissa, Greece
| | - Athanasios D Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41334 Larissa, Greece.
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14
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Ultrasound detection of aortoenteric fistula in a patient with sepsis. J Ultrasound 2017; 20:157-159. [PMID: 28593006 DOI: 10.1007/s40477-017-0249-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/11/2017] [Indexed: 10/19/2022] Open
Abstract
We report a case of an 81-year-old man, hospitalized for sepsis unresponsive to targeted antibiotic therapy, who underwent abdominal aortic aneurysmectomy with stent placement before 12 years. Point-of-care ultrasound examination showed the presence of a voluminous and inhomogeneous lesion adjacent to the anterior wall of aortic bifurcation with pulsatile flow from the aorta into the lesion, highlighted by Color-Doppler, and peripheral (closely with intestinal loops) floating hyperechoic spots marked by posterior comet tail artifact, suggestive for the presence of air bubbles. The presence of an aortoenteric fistula not excluding in differential diagnosis and the possibility of an abscess of aneurysmatic sac with colonization of gas-producing bacteria were suspected; an abdominal contrast-enhanced computed tomography was requested and it confirmed the suspicion of an aortoenteric fistula. The patient underwent emergency surgical intervention with good technical success (evidence of aorto-appendicular fistula), but he died the day after of cardiac arrest.
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15
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Kakkos SK, Bicknell CD, Tsolakis IA, Bergqvist D. Editor's Choice - Management of Secondary Aorto-enteric and Other Abdominal Arterio-enteric Fistulas: A Review and Pooled Data Analysis. Eur J Vasc Endovasc Surg 2016; 52:770-786. [PMID: 27838156 DOI: 10.1016/j.ejvs.2016.09.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 09/25/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To compare management strategies for secondary abdominal arterio-enteric fistulas (AEFs). METHODS This study is a review and pooled data analysis. Medline and Scopus databases were searched for studies published between 1999 and 2015. Particular emphasis was given to short- and long-term outcomes in relation to AEF repair type. RESULTS Two hundred and sixteen publications were retrieved, reporting on 823 patients. In-hospital mortality was 30.7%. Open surgery had higher in-hospital mortality (246/725, 33.9%), than endovascular methods (7/98, 7.1%, p < .001, OR 6.7, 95% CI 3-14.7, including staged endovascular to open surgery, 0/13, 0%). In-hospital mortality after graft removal/extra-anatomical bypass grafting was 31.2% (66/226), graft removal/in situ repair 34% (137/403), primary closure of the arterial defect 62.5% (10/16), and for miscellaneous open procedures 41.3% (33/80), p = .019. Among the subgroups of in situ repair, homografts were associated with a higher mortality than impregnated prosthetic grafts (p = .047). There was no difference in recurrent AEF-free rates between open and endovascular procedures. Extra-anatomical bypass/graft removal and in situ repair had a lower AEF recurrence rate than primary closure and homografts. Late sepsis occurred more often after endovascular surgery (2-year rates 42% vs. 19% for open, p = .001). The early survival benefit of endovascular surgery was blunted during follow-up, although it remained significant (p < .001). Within the in situ repair group, impregnated prosthetic grafts were associated with the worst overall and AEF related mortality free rates and vein grafts with the best. No recurrence, sepsis, or mortality was reported following staged endograft placement to open repair after a mean follow-up of 16.8 months (p = .18, p = .22, and p = .006, respectively, compared with patients in other groups). CONCLUSIONS Endovascular surgery, where appropriate, is associated with better early survival than open surgery for secondary AEFs. Most of this benefit is lost during long-term follow-up, implying that a staged approach with early conversion to in situ vein grafting may achieve the best results in selected patients.
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Affiliation(s)
- S K Kakkos
- Department of Vascular Surgery, University Hospital of Patras, Greece; Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK.
| | - C D Bicknell
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - I A Tsolakis
- Department of Vascular Surgery, University Hospital of Patras, Greece
| | - D Bergqvist
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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16
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Slama R, Long B, Koyfman A. The emergency medicine approach to abdominal vascular graft complications. Am J Emerg Med 2016; 34:2014-2017. [PMID: 27519454 DOI: 10.1016/j.ajem.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 06/30/2016] [Accepted: 07/02/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Abdominal aortic aneurysm (AAA) is a deadly condition, particularly with rupture. Emergency physicians provide vital frontline care to the diagnosis and treatment of this disease. Endovascular aortic repair (EVAR) has become the gold standard for treatment of AAA, but the management of EVAR complications is not well discussed in the emergency medicine literature. OBJECTIVE OF THIS REVIEW The purpose of this article is to provide an emergency medicine-focused review of the complications of EVAR. DISCUSSION Although many complications may arise after AAA repair, the most common include aortoenteric fistula, endoleak, limb ischemia, and graft infection. All potential complications should receive vascular surgery consultation and hemodynamic resuscitation. Aortoenteric fistula often presents nonspecifically with gastrointestinal (GI) bleeding, abdominal pain, and vomiting. Computed tomography with intravenous contrast is required for diagnosis. An endoleak is defined by vascular flow outside of the graft. The optimal diagnostic modality includes triple phase computed tomographic scan (noncontrast, arterial, delayed phase). Limb ischemia may occur before 2 months, or in a later period, with symptoms ranging from claudication to complete neurovascular compromise. Graft infection is most commonly due to Staphylococcus aureus, and imaging can suggest the diagnosis. Definitive diagnosis requires tissue or fluid sampling. Through an understanding of these complications, emergency physicians may improve patient outcomes. CONCLUSIONS With the growing use of EVAR, emergency physician exposure to complications of this procedure is increasing. Knowledge of the complication presentations, diagnoses, and management can play an integral role patient care.
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Affiliation(s)
- Richard Slama
- Naval Medical Center Portsmouth, Department of Emergency Medicine, 620 John Paul Jones Cir, Portsmouth, VA 23708, USA.
| | - Brit Long
- San Antonio Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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17
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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: 29] [Impact Index Per Article: 3.2] [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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18
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Essentials of endovascular abdominal aortic aneurysm repair imaging: postprocedure surveillance and complications. AJR Am J Roentgenol 2014; 203:W358-72. [PMID: 25247965 DOI: 10.2214/ajr.13.11736] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Lifelong postprocedural imaging surveillance is necessary after endovascular abdominal aortic aneurysm repair (EVAR) to assess for complications of endograft placement, as well as device failure and continued aneurysm growth. Refinement of the surveillance CT technique and development of ultrasound and MRI protocols are important to limit radiation exposure. CONCLUSION A comprehensive understanding of EVAR surveillance is necessary to identify life-threatening complications and to aid in secondary treatment planning.
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Karczewski M, Kulesza J, Cichanska L, Adamska Z, Stronka M. Endovascular Abdominal Aortic Aneurysm Repair in a Kidney Transplant Patient After an Iatrogenic Iliac Artery Dissection. EXP CLIN TRANSPLANT 2014; 14:450-3. [PMID: 25365292 DOI: 10.6002/ect.2014.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 64-year-old man who had undergone a renal transplant 9 years earlier, was admitted to our hospital because of an asymptomatic, large, abdominal aortic aneurysm. During an introduction of a guide wire to the left common femoral artery dissection of iliac artery occurred with occlusion of graft renal artery. And endarterectomy of the common, external, and internal iliac arteries was performed, with no sufficient kidney inflow. A bypass was performed between the common iliac and the left common femoral artery with a kidney artery reanastomosis to the prosthesis. After 4 months of endovascular treatment of the aortic aneurysm, the patient's renal function remained unchanged.
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Affiliation(s)
- Marek Karczewski
- From the Department of Transplantology, General and Vascular Surgery, Clinical Hospital of Poznan University of Medical Sciences, Poland
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20
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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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21
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Kasashima S, Kawashima A, Kasashima F, Endo M, Matsumoto Y, Kawakami K, Kayahara M, Ohta H, Yano M, Marukawa Y. Immunoglobulin G4–Related Periaortitis Complicated by Aortic Rupture and Aortoduodenal Fistula After Endovascular AAA Repair. J Endovasc Ther 2014; 21:589-97. [DOI: 10.1583/14-4670r.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Affiliation(s)
- Zacharia T. Bazzi
- Department of Vascular Surgery; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Raffi Qasabian
- Department of Vascular Surgery; Royal Prince Alfred Hospital; Sydney New South Wales Australia
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23
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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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24
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Kao YT, Shih CM, Lin FY, Tsao NW, Chang NC, Huang CY. An endoluminal aortic prosthesis infection presenting as pneumoaorta and aortoduodenal fistula. World J Gastroenterol 2012; 18:5309-11. [PMID: 23066329 PMCID: PMC3468867 DOI: 10.3748/wjg.v18.i37.5309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 05/04/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
Herein, we present a case of pneumoaorta and aortoduodenal fistula (ADF) caused by an endoluminal aortic prosthesis infection. An 82-year-old man underwent endovascular aneurysm repair with a stent graft to exclude a 5.1-cm abdominal aortic aneurysm. Three months after the index procedure, the patient was taken to the emergency department at a medical university hospital. He presented with a 2-d history of bloody diarrhea. An endoluminal aortic stent graft infection was diagnosed, and an ADF was identified. The patient died of septic shock despite emergency surgery and intensive care. When encountered, stent graft infections require appropriate antibiotics and graft explantation. The diagnosis of an ADF is important, and surgery remains the most effective management if septic shock presents despite conservative treatment.
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Lind BB, Jacobs CE. Primary Aortoduodenal Fistula Supplied by Type II Endoleak. Ann Vasc Surg 2012; 26:1012.e13-5. [DOI: 10.1016/j.avsg.2012.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 01/27/2012] [Accepted: 02/12/2012] [Indexed: 10/27/2022]
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26
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McPhee JT, Soybel DI, Oram RK, Belkin M. Primary aortoenteric fistula following endovascular aortic repair due to type II endoleak. J Vasc Surg 2011; 54:1164-6. [DOI: 10.1016/j.jvs.2011.04.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Revised: 04/20/2011] [Accepted: 04/21/2011] [Indexed: 11/29/2022]
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27
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Fernández-Samos Gutiérrez R, Martínez Mira C, Alonso Argüeso G, Peña Cortés R, Alonso Alvarez M, Vaquero Morillo F. Fístula aortoentérica post-EVAR. Presentación de un caso y revisión de la literatura. ANGIOLOGIA 2011. [DOI: 10.1016/j.angio.2011.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Park HS, Jung IM, Soh YH, Cho BS, Ahn YJ, Chung JK. Experience of non-vascular complications following endovascular aneurysm repair for abdominal aortic aneurysm. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 80 Suppl 1:S67-70. [PMID: 22066089 PMCID: PMC3205366 DOI: 10.4174/jkss.2011.80.suppl1.s67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 05/25/2010] [Indexed: 11/30/2022]
Abstract
Endovascular aneurysm repair (EVAR) for the treatment of abdominal aortic aneurysm (AAA) is a widely used method, and its decreased invasiveness compared to traditional surgical repair has brought about reduced rates of morbidity and mortality. Several vascular complications related to the procedure have been reported, but non-vascular complications have rarely occurred. We report herein the case of a 78-year-old man who underwent EVAR for AAA and presented with active duodenal ulcer bleeding and acute acalculous cholecystitis as complications after the procedure. We must consider that a wide spectrum of complications may occur following EVAR, and therefore it is important to evaluate the risks of complication and to take the necessary measures to minimize them.
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Affiliation(s)
- Hyung Sub Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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29
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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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30
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Lane JS, Barleben AR, Kubaska SM, Fujitani RM. Aortoduodenal fistula after endovascular aneurysm repair presenting with aneurysm sac abscess. J Vasc Surg 2009; 50:919-20. [DOI: 10.1016/j.jvs.2008.09.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 09/25/2008] [Accepted: 09/25/2008] [Indexed: 10/21/2022]
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31
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Chenu C, Marcheix B, Barcelo C, Rousseau H. Aorto-enteric Fistula After Endovascular Abdominal Aortic Aneurysm Repair: Case Report and Review. Eur J Vasc Endovasc Surg 2009; 37:401-6. [DOI: 10.1016/j.ejvs.2008.11.037] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 11/24/2008] [Indexed: 11/28/2022]
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32
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Góes Junior AMDO, Petnys A, Rabboni E, Neves Junior MAD, Petterle PH, Melo RC, Protta TR, Terci W. Oclusão duodenal após cirurgia da aorta abdominal: relato de caso. J Vasc Bras 2009. [DOI: 10.1590/s1677-54492009005000003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A maior parte dos artigos sobre obstrução duodenal após cirurgia aórtica cita dados referentes às correções da doença aneurismática e não da doença aterosclerótica. Não obstante, é consenso que se trata de uma complicação rara, cuja incidência é menor do que 1%. Os autores relatam o caso de um paciente submetido a enxerto aorto-bifemoral que apresentou, como complicação pós-operatória, oclusão duodenal. O paciente foi tratado com reintervenção cirúrgica e uso de remendo de grande omento para síntese do retroperitônio. A revisão da literatura indica que a maioria dos casos responde bem ao tratamento conservador, e a conduta cirúrgica normalmente só é necessária quando aderências são a causa da obstrução ou quando o tratamento clínico não é satisfatório após 2 semanas.
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33
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Zimmerman PM, Cherr GS, Angelos GC, Gona J, Dosluoglu HH. Is F 18 Fluorodeoxyglucose Positron Emission Tomography Too Sensitive for the Diagnosis of Vascular Endograft Infection? Vascular 2008; 16:346-9. [DOI: 10.2310/6670.2008.00049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case of a false positive fluorodeoxyglucose positron emission tomography (FDG-PET) scan in a patient who presented with abdominal pain, and gastrointestinal bleeding accompanied by elevation of inflammatory markers, seven weeks after a proximal type I endoleak repair with a cuff extension. Aortoenteric fistula and endograft infection was ruled out by laparotomy. FDG-PET image may have a role in diagnosis of infection, but false positive results are possible and caution is necessary if other data are non-confirmatory.
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Affiliation(s)
- Pamela M. Zimmerman
- *Division of Vascular and Endovascular Surgery, West Virginia University, Morgantown, WV; †Division of Vascular Surgery, Department of Surgery, ‡School of Medicine, and §Department of Nuclear Medicine, State University of New York at Buffalo, Buffalo, NY; ‖VA Western New York Healthcare System, Buffalo, NY
| | - Gregory S. Cherr
- *Division of Vascular and Endovascular Surgery, West Virginia University, Morgantown, WV; †Division of Vascular Surgery, Department of Surgery, ‡School of Medicine, and §Department of Nuclear Medicine, State University of New York at Buffalo, Buffalo, NY; ‖VA Western New York Healthcare System, Buffalo, NY
| | - George C. Angelos
- *Division of Vascular and Endovascular Surgery, West Virginia University, Morgantown, WV; †Division of Vascular Surgery, Department of Surgery, ‡School of Medicine, and §Department of Nuclear Medicine, State University of New York at Buffalo, Buffalo, NY; ‖VA Western New York Healthcare System, Buffalo, NY
| | - Jayakumari Gona
- *Division of Vascular and Endovascular Surgery, West Virginia University, Morgantown, WV; †Division of Vascular Surgery, Department of Surgery, ‡School of Medicine, and §Department of Nuclear Medicine, State University of New York at Buffalo, Buffalo, NY; ‖VA Western New York Healthcare System, Buffalo, NY
| | - Hasan H. Dosluoglu
- *Division of Vascular and Endovascular Surgery, West Virginia University, Morgantown, WV; †Division of Vascular Surgery, Department of Surgery, ‡School of Medicine, and §Department of Nuclear Medicine, State University of New York at Buffalo, Buffalo, NY; ‖VA Western New York Healthcare System, Buffalo, NY
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Saratzis N, Saratzis A, Melas N, Ktenidis K, Kiskinis D. Aortoduodenal Fistulas After Endovascular Stent-Graft Repair of Abdominal Aortic Aneurysms:Single-Center Experience and Review of the Literature. J Endovasc Ther 2008; 15:441-8. [DOI: 10.1583/08-2377.1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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35
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Bergqvist D, Björck M, Nyman R. Secondary Aortoenteric Fistula after Endovascular Aortic Interventions: A Systematic Literature Review. J Vasc Interv Radiol 2008; 19:163-5. [PMID: 18341942 DOI: 10.1016/j.jvir.2007.10.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 10/05/2007] [Accepted: 10/08/2007] [Indexed: 11/15/2022] Open
Affiliation(s)
- David Bergqvist
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Uppsala SE 751 85, Sweden.
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36
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Abstract
Ischemic colitis is a well-described complication of major vascular surgery, especially following open abdominal aortic aneurysm repair and endovascular aneurysm repair, but also with aortoiliac surgery, aortic dissection, and thoracic aneurysm repair. Following its onset, mortality remains high, highlighting the need for rapidly identifying the onset of symptoms and, perhaps more importantly, those patients at risk, in an attempt to prevent its onset. In this article, the authors review the causes, presentation, and diagnostic strategies of colonic ischemia. They also cover the operative management and outcomes for bowel resection and vascular repair. Finally, they evaluate some of the newer options for diagnosing this condition.
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Affiliation(s)
- Scott R Steele
- Department of Surgery, Madigan Army Medical Center, Fort Lewis, WA 98431, USA.
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