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.
ArmstrongPABackMRWilsonJSShamesMLJohnsonBLBandykDF. Improved outcomes in the recent management of secondary aortoenteric fistula. J Vasc Surg. 2005;42(4):660–666.
2.
KakkosSKBicknellCDTsolakisIABergqvistD. Management of secondary aorto-enteric and other abdominal arterio-enteric fistulas: a review and pooled data analysis. Eur J Vasc Endovasc Surg. 2016;52(6):770–786.
3.
AntonelloRMD’OriaMCavallaroM, et al.Management of abdominal aortic prosthetic graft and endograft infections. A multidisciplinary update. J Infect Chemo. 2019;25(9):669–680.
4.
RubyBJCogbillTH. Aortoduodenal fistula 5 years after endovascular abdominal aortic aneurysm repair with the ancure stent graft. J Vasc Surg. 2007;45(4):834–836.
5.
d’OthéeBJSoulaPOtalP, et al.Aortoduodenal fistula after endovascular stent-graft of an abdominal aortic aneurysm. J Vasc Surg. 2000;31(1 Pt 1):190–195.
6.
LindBBJacobsCE. Primary aortoduodenal fistula supplied by type II endoleak. Ann Vasc Surg. 2012;26(7):1012.e13-e15.
7.
ZakiMTawfickWAlawyMElKassabyMHynesNSultanS. 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(10):710–713.
NguyenCLLindsayAMcLachlanRIslamSQasabianRLoaJ. Aortoduodenal fistula 2 years after elective endovascular repair of an abdominal aortic aneurysm. ANZ J Surg. 2020.
10.
FarresHGonzalesAJGarrettHEJr. Aortoduodenal fistula after endograft repair of abdominal aortic aneurysm secondary to a retained guidewire. J Vasc Surg. 2012;56(5):1413–1415.
11.
SaratzisNSaratzisAMelasNKtenidisKKiskinisD. Aortoduodenal fistulas after endovascular stent-graft repair of abdominal aortic aneurysms: single-center experience and review of the literature. J Endovasc Ther. 2008;15(4):441–448.
12.
LeeBNeschisDG. Late-term complication of endograft repair for aortoenteric fistula. Vasc Endovasc Surg. 2010;44(5):395–398.
13.
MoulakakisKGSfyroerasGSMylonasSN, et al.Outcome after preservation of infected abdominal aortic endografts. J Endovasc Ther. 2014;21(3):448–455.
14.
BurksJAJrFariesPLGravereauxECHollierLHMarinML. Endovascular repair of bleeding aortoenteric fistulas: a 5-year experience. J Vasc Surg. 2001;34(6):1055–1059.
15.
HowardRKurzSShermanMAUnderhillJEliasonJLColemanDM. Contemporary management of secondary aortoduodenal fistula. Ann Vasc Surg. 2015;29(8):1614–1618.
16.
GnusJFerencSKościelnaM, et al.Secondary aortoenteric fistula after abdominal aortic graft implementation in our own material. Adv Clin Exp Med. 2016;25(6):1265–1271.
17.
BeijerEScholtesVPWMoerbeekPCoveliersHMELelyRJHoksbergenAWJ. Endovascular treatment of aortic stump blow-out after extra-anatomical repair of aortoduodenal fistula: a case report and review of literature. CVIR Endovasc. 2020;3(1):1–6.
18.
WalterCTaherFRiegerHAssadianAFalkensammerJ. Endograft infection due to secondary aortoenteric fistula treated with custom-made bovine in situ aortic bifurcation graft. Vasc Endovasc Surg. 2019;53(2):165–169.
19.
LutzBReepsCBiroGKnappichCZimmermannAEcksteinHH. Bovine pericardium as new technical option for in situ reconstruction of aortic graft infection. Ann Vasc Surg. 2017;41:118–126.
20.
WalkerWECooleyDADuncanJMHallmanGLJrOttDAReulGJ. The management of aortoduodenal fistula by in situ replacement of the infected abdominal aortic graft. Ann Surg. 1987;205(6):727–731.
21.
SuckowBDGoodneyPPColumboJA, et al.National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients. J Vasc Surg. 2018;67(6):1690–1697.
