Contemporary Management of Secondary Aortoduodenal Fistula

Howard, Ryan; Kurz, Sarah; Sherman, Matthew A.; Underhill, Joshua M.; Eliason, Jonathan L.; Coleman, Dawn M.

doi:10.1016/j.avsg.2015.06.090

Cited by 13 publications

(15 citation statements)

References 14 publications

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“…Secondary aortoenteric fistula is a devastating complication of aortic surgery; its presentation and diagnosis are welldescribed. 1,2,[14][15][16] Its treatment has evolved considerably. Historically, post-operative aortoenteric fistula has required laparotomy, surgical repair of the bowel, excision of the infected graft, oversewing of the aortic stump and extra-anatomic revascularization.…”

Section: Discussionmentioning

confidence: 99%

“…Historically, post-operative aortoenteric fistula has required laparotomy, surgical repair of the bowel, excision of the infected graft, oversewing of the aortic stump and extra-anatomic revascularization. 15 This complex operation carries a high risk of morbidity, mortality and recurrence including an alarming incidence of "blowout" of the defunctionalized aortic stump. 17 Several alternative operative approaches have been suggested, most notably in situ replacement of the aortic prosthesis with antibiotic-soaked prosthetic or a tissue conduit such as autogenous superficial femoral vein or cryopreserved aortic homograft.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Post-Evar Aortoduodenal Fistula Without Endograft Excision

Joshi

Ogbudinkpa

Stecher

et al. 2020

Vasc Endovascular Surg

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment of Post-Evar Aortoduodenal Fistula Without Endograft Excision

Joshi

Ogbudinkpa

Stecher

et al. 2020

Vasc Endovascular Surg

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“…Surgical repair of AEF is associated with 14% to 70% mortality rate. 6,11 Symptoms of stent graft infection and AEF include chronic fever, abdominal pain, leukocytosis, bacteremia, weight loss, weakness, and bleeding, but reportedly 10% of patients remain asymptomatic. 3,6,12 Chaufour et al reported a median time from initial EVAR and first signs of infection of 414 days (range up to 9 years) and a median time to endograft explantation of 30 days (range up to 2.2 years).…”

Section: Discussionmentioning

confidence: 99%

Endograft Infection Due to Secondary Aortoenteric Fistula Treated With Custom-Made Bovine In Situ Aortic Bifurcation Graft

Walter

Taher

Rieger

et al. 2018

Vasc Endovascular Surg

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Purpose: To increase awareness of the clinical presentation, diagnostic workup, and treatment options for endograft infections. Case Report: A 75-year-old male patient was admitted with suspected endograft infection 4 years after endovascular aortic aneurysm repair (EVAR). Although preoperative diagnostics showed no definitive signs of endograft infection, eventual surgical exposure of the endograft revealed signs of advanced inflammation, including the unexpected finding of an aortoduodenal fistula. Conclusion: A detailed evaluation of patient history and clinical examination, performed as a part of routine follow-ups, may be beneficial in identifying possible severe complications after EVAR early on. Regarding options for aortic reconstruction in case of endograft infection, bovine pericardium deserves consideration as a promising, feasible, and easily available graft material.

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“…Duodenal reconstructive techniques include primary repair, resection with primary anastomosis and exclusion. A retrospective review by Howard et al 24 compared different approaches; duodenal leaks remained the major complication, delaying recovery and increasing morbidity and mortality. Duodenal exclusion with gastrojejunostomy had the lowest rate of duodenal leaking.…”

Section: Discussionmentioning

confidence: 99%

Secondary aortoduodenal fistula and the unrecognised herald bleed

Alari¹,

González²,

Gutierrez³

et al. 2017

BMJ Case Reports

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A 65-year-old man with history of aortobifemoral surgery 4 years ago was admitted to hospital after sudden abdominal pain. Initially misdiagnosed as renal colic, he was treated with analgesics, and while on observation he started with haematemesis, rapidly responding to volume infusion. Upper gastrointestinal endoscopy showed fresh blood in the stomach with no visible active bleeding. CT scan showed an important contrast extravasation from the aorta to the third duodenal portion, restarting haemodynamic instability and a cardiac arrest. Cardiopulmonary resuscitation (CPR) manoeuvres followed by intense fluid resuscitation and urgent laparotomy with a fast transabdominal supracoeliac aortic clamping was performed. After multiple blood and plasma unit transfusion and intravenous norepinephrine, two more cardiac arrests were recovered. Unfortunately, after aggressive management, the patient rapidly deteriorated and deceased on the table. Aortoduodenal fistula is a rare entity causing life-threatening bleeding. Its diagnosis requires high clinical suspicion and surgery offers the only hope for survival.

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Contemporary Management of Secondary Aortoduodenal Fistula

Cited by 13 publications

References 14 publications

Treatment of Post-Evar Aortoduodenal Fistula Without Endograft Excision

Treatment of Post-Evar Aortoduodenal Fistula Without Endograft Excision

Endograft Infection Due to Secondary Aortoenteric Fistula Treated With Custom-Made Bovine In Situ Aortic Bifurcation Graft

Secondary aortoduodenal fistula and the unrecognised herald bleed

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