Aorto-enteric Fistula Following Endovascular Repair of Abdominal Aortic Aneurysm

Makar, Ragai R.; Reid, J.; Pherwani, A.D.; Johnston, L. C.; Hannon, R.J.; Lee, B.; Soong, Chee V.

doi:10.1053/ejvx.2001.0071

Cited by 10 publications

(15 citation statements)

References 4 publications

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“…Several authors hypothesized that during aortic endovascular repair, fistulas with surrounding structures may arise secondary to the erosion of the metallic stent through the aorta. 4,[13][14][15][16] In our case, graft thrombosis was caused when we deployed a bare metal stent in a recently endarterectomized infrarenal aorta to correct the intimal flap originating from an aortic endarterectomy. Specifically, the mechanical features of the Palmaz stent render it inflexible or stiff compared with other endovascular devices.…”

Section: Discussionmentioning

confidence: 83%

Aortoenteric fistula as a late complication of thrombolysis and bare metal stenting for perioperative occlusion of aortofemoral bypass

Tshomba

Kahlberg

Marone

et al. 2006

Journal of Vascular Surgery

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We previously described the case of a 47-year-old man who experienced perioperative graft occlusion after infrarenal aortic endarterectomy and aortobifemoral expanded polytetrafluoroethylene bypass graft for occlusive disease. The patient was treated with local graft thrombolysis and stenting of an intimal flap at the level of the endarterectomized aorta next to the aortic anastomosis. An urgent laparotomy performed 6 years later showed aortic wall perforation by the stent with a large aortoenteric fistula. Surgical treatment included removal of the stent and the aortobifemoral graft, bowel repair, and extra-anatomic lower-limb revascularization by axillofemoral and cross-femoral bypass grafting. The patient was discharged 12 days later with no early complications. Although local thrombolysis and stenting may be a technically feasible technique instead of reoperation in early aortofemoral graft thrombosis, long-term results of this procedure may be affected by perigraft hematoma due to perioperative thrombolysis, increased risk of infection due to the prolonged intragraft cannulation, and risk of stent-related aortic injury, especially if an endarterectomy has been performed. All these issues may increase the risk of late aortoenteric fistula. More experience with hybrid, open/endovascular procedures, and more contemporary stent-based devices is needed to assess the efficacy and safety of this alternative treatment.

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Section: Discussionmentioning

confidence: 83%

Aortoenteric fistula as a late complication of thrombolysis and bare metal stenting for perioperative occlusion of aortofemoral bypass

Tshomba

Kahlberg

Marone

et al. 2006

Journal of Vascular Surgery

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“…Of the 19 cases of aortic stent-graft infections now reported in the literature, 9,10 only 8 involved aortoenteric fistulas, [2][3][4][5][6][7][8] and the majority occurred Ͼ1 year after the endovascular repair. Two were due to graft migration and kinking of the device while the third followed disruption of the suture between the supporting stent and the endograft.…”

Section: Discussionmentioning

confidence: 99%

“…Thankfully, late endograft infection has so far been relatively rare. [1][2][3][4][5][6][7][8][9][10] We add to the few reported cases a patient who developed late stent-graft infection with aortoenteric fistula.…”

mentioning

confidence: 99%

Aortic Stent-Graft Infection Due to a Presumed Aortoenteric Fistula

et al. 2002

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“… Normal contact traction: Normal contact tractions t n in combination with friction between SG and vessel are responsible for the passive fixation of the SG in the vessel. However, local hot spots with excessive normal contact traction might also trigger local tissue remodeling or even might lead to erosion of the vessel wall 46,47 Stent stress: The Cauchy von Mises equivalent stress measure is used to assess the stress state in the stent.…”

Section: Methodsmentioning

confidence: 99%

Customized stent‐grafts for endovascular aneurysm repair with challenging necks: A numerical proof of concept

Hemmler

Lin

Thierfelder

et al. 2020

Numer Methods Biomed Eng

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Endovascular aortic repair (EVAR) is a challenging intervention whose longterm success strongly depends on the appropriate stent-graft (SG) selection and sizing. Most off-the-shelf SGs are straight and cylindrical. Especially in challenging vessel morphologies, the morphology of off-the-shelf SGs is not able to meet the patient-specific demands. Advanced manufacturing technologies facilitate the development of highly customized SGs. Customized SGs that have the same morphology as the luminal vessel surface could considerably improve the quality of the EVAR outcome with reduced likelihoods of EVAR related complications such as endoleaks type I and SG migration. In this contribution, we use an in silico EVAR methodology that approximates the deployed state of the elastically deformable SG in a hyperelastic, anisotropic vessel. The in silico EVAR results of off-the-shelf SGs and customized SGs are compared qualitatively and quantitatively in terms of mechanical and geometrical parameters such as stent stresses, contact tractions, SG fixation forces and the SG-vessel attachment. In a numerical proof of concept, eight different vessel morphologies, such as a conical vessel, a barrel shaped vessel and a curved vessel, are used to demonstrate the added value of customized SGs compared to off-the-shelf SGs. The numerical investigation has shown large benefits of the highly customized SGs compared to off-the-shelf SGs with respect to a better SG-vessel attachment and a considerable increase in SG fixation forces of up to 50% which indicate decreased likelihoods of EVAR related complications. Hence, this numerical proof of concept motivates further research and development of highly customized SGs for the use in challenging vessel morphologies. K E Y W O R D Sabdominal aortic aneurysm, customized stent-graft, endovascular repair, personalized medicine

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Aorto-enteric Fistula Following Endovascular Repair of Abdominal Aortic Aneurysm

Cited by 10 publications

References 4 publications

Aortoenteric fistula as a late complication of thrombolysis and bare metal stenting for perioperative occlusion of aortofemoral bypass

Aortoenteric fistula as a late complication of thrombolysis and bare metal stenting for perioperative occlusion of aortofemoral bypass

Aortic Stent-Graft Infection Due to a Presumed Aortoenteric Fistula

Customized stent‐grafts for endovascular aneurysm repair with challenging necks: A numerical proof of concept

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