Emergent endovascular treatment of a bleeding recurrent aortoenteric fistula as a “bridge” to definitive surgical repair

• Published in: Journal of vascular surgery 2012-04, Vol.55 (4), p.1160-1163
• Main Authors: Marone, Enrico Maria, MD, Mascia, Daniele, MD, Kahlberg, Andrea, MD, Tshomba, Yamume, MD, Chiesa, Roberto, MD
• Format: Article
• Language: English
• Subjects: Abdominal Pain - diagnosis; Abdominal Pain - etiology; Aortic Aneurysm, Abdominal - complications; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Balloon Occlusion - instrumentation; Balloon Occlusion - methods; Biological and medical sciences; Combined Modality Therapy; Emergency Service, Hospital; Emergency Treatment - methods; Follow-Up Studies; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - therapy; Humans; Intestinal Fistula - complications; Intestinal Fistula - therapy; Male; Medical sciences; Middle Aged; Neurology; Radiography; Recurrence; Risk Assessment; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Vascular Fistula - complications; Vascular Fistula - therapy; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures - methods
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2011.10.023

We report the case of a 59-year-old man who developed a recurrent aortoenteric fistula (AEF) following previous aorto-bifemoral bypass grafting and subsequent AEF open repair with aorto-bifemoral graft excision and extra-anatomic reconstruction. The patient was treated emergently by means of endovascular plug deployment via a left brachial approach into the infrarenal aortic stump, obtaining recovery of hemodynamic stability. Five days later, he underwent elective relaparotomy, aortic plug removal, infrarenal aortic ligature, and duodenal repair. Endovascular strategies to rapidly stop bleeding associated with recurrent AEF may serve as a “bridge” to definitive open repair, as in the case discussed herein. Even if rare, recurrent AEF following previous prosthetic aortic graft excision and extra-anatomic revascularization represents a dreadful event. Since surgical treatment is technically demanding and time consuming in emergent settings, we present an “unconventional” endovascular option to obtain quick cessation of aortic bleeding.