Aortoduodenal fistula after endovascular aortic repair of an infected abdominal aortic aneurysm

• DOI: 10.3760/cma.j.issn.0366-6999.20122572
• Publication Date: 2024-01-16T18:23:32Z
• Authors: Jian Zhang; Jun Zhao; Jia-cai Mei; Ming-zhe Shao; Ye Pan; Qi Zheng
• Keywords: Aortoenteric Fistula

To the editor: We report a case of aortoduodenal fistula presenting as right lower limb ischemia and infection after endovascular aortic repair (EVAR) an infected abdominal aneurysm (AAA). A above knee amputation was performed for septic embolism ilio-femoral arteries before stent-graft finally diagnosed. Then extra-anatomic revascularization left limb, following by explantation rebuilding gastro-intestinal continuity were done. our knowledge, this is first successfully treated method in China. 62-year-old man with undiagnosed pain two months admitted to department. Tenderness found his flank. There no antecedent history arterial injury. C-reactive protein level 125 mg/L white blood cell count 18 × 106/L. Contrast-enhanced computed tomography (CT) scan revealed infra-renal AAA measuring 5.5 cm maximun diameter abscess anterior sac (Figure 1A). No bacteria cultures. EVAR bifurcated (Talent, 26/12*145 cm, Medtronic Co., USA) under local anesthesia. endoleak, migration kinking. One month later, patient got repeated fever (39°C-40°C) which could be controlled antibiotic therapy. CT shrinkage aneurismal reduction 1B) only. The intermittent continued almost three years, cultures unremarkable. evidence tuberculosis.Figure 1.: Perioperative intraoperative view patient. A: Preoperative showed aneurysmal sac. B: 2 gradual abscess. C: 3 years multiple locules air within branch stent-graft. D: bile stained thrombus. E: 1 removal patent bypass.The sudden rest EVAR, accompanied abscesses thigh. angiography occlusion superficial femoral artery distal arteries. Above-knee then subsided. However, subcutaneous developed groin later. external iliac full thrombus at debridement. Multiple stent graft immediate enhanced 1C), confirming infection. axillary-femoral bypass polytetrafluoroethylene (7 mm 80 mm, Gore-Tex Intering, Gore performed. Subsequent laparotomy between third segment duodenum initial endograft there lot its 1D). infrarenal aorta ligated over-sewed, common ligated. side-to-side gastro-jejunostomy drainage Prolonged therapy given postoperatively. one operation 1E). Although aneurysms are very rare, they among most difficult treat.1,2 incorporation adjacent organs into periaortic inflectious process makes them susceptible damage during open surgical confers high morbidity mortality. might simplify procedure theoretically provide good alternative treating aneurysms. outcome data long-term results limited due their rarity. Controversy also exists about optimal treatment EVAR. several recent studies excellent short-term fistula, outcomes disappointing.3 prefer remove perfom post-EVAR fistula. prolonged should recommended patients life-threatening bleeding or poor candidates repair. Infected related both rare but fatal events. potential problems Extra-anatomic remains gold standard treat Jian Zhang Jun Zhao Jia-cai Mei Ming-zhe Shao Ye Pan Qi Zheng Department Vascular Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 200231, China (Zhang J, JC, MZ, Y Q)