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. 2020 Dec 26;2020(12):rjaa520.
doi: 10.1093/jscr/rjaa520. eCollection 2020 Dec.

Roles of endovascular aneurysm repair in management of secondary aorto-enteric fistulas

Barnaby Jmc Farquharson  1 , Leanna Erete  1 , Luke Morgan-Rowe  1 , Matthew Metcalfe  1
Affiliations

Roles of endovascular aneurysm repair in management of secondary aorto-enteric fistulas

Barnaby Jmc Farquharson et al. J Surg Case Rep. .

Abstract

Secondary aorto-enteric fistulas (AEFs) are an uncommon but serious complication of abdominal aortic aneurysm (AAA) repair. Case review of two cases of secondary AEF are as follows: the first case involved a 75-year- old male who presented with AEF 1 year post-emergency open AAA repair, successfully managed with endovascular aortic aneurysm repair (EVAR) without complication. The second case involved a 75-year-old male patient 14 months post open AAA repair for an inflammatory aneurysm who presented with an iliac-enteric fistula. The previous repair was relined with a bifurcated EVAR with subsequent laparotomy and resection of the affected portion of the small bowel. Both patients on lifelong antibiotics without further episodes of sepsis, recurrence of AEF or mortality at 12 months follow up. EVAR can be successful in the management of secondary AEF. Careful patient selection, accurate image interpretation, and expedient management are key factors to successful short- and long-term outcomes.

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Figures

Figure 1
Figure 1
(a) Axial thick slice of a CT with IV contrast in the arterial phase shows the lumen of the surgical graft (yellow arrow), clear contrast opacification within the fistula (red line and arrow) and the duodenum (blue line and arrow) consistent with active haemorrhage; (b) sagittal reconstruction of a CT with IV contrast in the arterial phase showing the overlapping aortic stent grafts inserted to exclude the AEF from the circulation.
Figure 2
Figure 2
(a) Preoperative coronal thick slice of a CT with IV contrast in the arterial phase shows aneurysmal aorta with normal calibre common iliac arteries; however, inflammatory change around the aortic aneurysm is seen extending into the proximal iliac bifurcation (blue outline); (b) axial slice of a CT with IV contrast in the arterial phase shows aneurysmal common iliac arteries (red arrow), a clear saccular bulge (blue outline) into an adhered loop of small bowel (orange outline and arrow); the site of the fistulation.
See this image and copyright information in PMC

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