Coexisting Aortoenteric and Aortovesical Fistulae after Endovascular Aortic Repair of Abdominal Aortic Aneurysm: A Case Report

Abstract

Introduction: Aortoenteric or aortovesical fistulae often occurred primarily with abdominal aorta aneurysm (AAA). Literature retrieval indicated that this might be the first report of such complication secondary to Endovascular aorta repair (EVAR). Case presentation:A 71 year-old man who had accepted EVAR for AAA 2 years ago suffered from persistent fever, abdominal pain, hematuria and intermittent bloody stools. Cystoscopy revealed a fistula located at the bladder dome with persistent low-grade blood flow. Computed tomographic angiography (CTA) revealed a large AAA with slight type I B endoleak located within the distal end of left external iliac artery stent. Contrast was detected within the bowel and bladder. After strict antibiotic preparation, the patient received axillo-bifemoral arterial bypass, graft excision, bladder repair, and partial resection of the ileum. The patient was successfully treated and no severe complications occurred during the 2 years follow-up. Conclusion:Co-existing aortoenteric and aortovesical fistulae are extremely rare complication following EVAR. Surgical treatment is vital to avoid fatal results.