Secondary aortoenteric fistula after endovascular aortic interventions: a systematic literature review

Abstract

Purpose: To evaluate the collective incidence of, and experience with, aortoenteric fistula after endovascular aortoiliac therapy.

Materials and methods: A systematic literature research was performed to identify cases of aortoenteric fistulation after aortic stent-graft procedures or stent implantation.

Results: The review revealed 16 cases of aortoenteric fistulation after aortic stent-grafting (n = 15) or stent placement (n = 1), in 14 patients with abdominal aortic aneurysm. Six had undergone endovascular aneurysm repair because of what was considered a "hostile abdomen." The symptoms did not differ from those in patients with arterioenteric fistulation after open aortic repair. A defect in the stent-graft or its function was the predominant cause of fistulation. One fistula was diagnosed at autopsy, two patients died perioperatively, and 13 survived with in situ repair or an axillobifemoral graft, all after removal of the stent-graft or stent. However, the follow-up time was short, longer than 1 year in only five of the 13 survivors.

Conclusions: Aortoenteric fistulation does occur after endovascular implantation of stents and stent-grafts. The incidence is unknown but is probably low. Follow-up time in most publications was less than 1 year, which is considered short to assess potential graft infection.