Endovascular Aortic Occlusion for a Secondary Aorto-Enterocutaneous Fistula:44-Month Follow-up

Abstract

To describe the durability of endovascular aortic occlusion as an alternative treatment of an aortoenteric fistula in a severely unstable patient. A 47-year-old patient with a history of numerous previous vascular reconstructions underwent surgical exclusion of a persistent aorto-enterocutaneous fistula originating from a former colostomy site in proximity with the occluded left leg of an aortobifemoral bypass. Nine weeks later, he presented in profound hypovolemic shock from bleeding via the cutaneous remnant of the fistula and gastrointestinal tract. Because of the severe shock, recent surgery, and lack of a suitable endograft for the small-caliber aorta (19 mm), endovascular exclusion of the fistula was undertaken by occluding the infrarenal aorta. Talent occluders were also placed in the right femoral bypass limb and the right common iliac artery. An extra-anatomical bypass was created to revascularize the lower extremities. The patient was discharged in good condition on day 20. The fistula spontaneously regressed after 12 months. Since the patient refused further surgery, 44-month follow-up is now available. There are no signs of reinfection or recurrent aortoenteric fistula. Endovascular occlusion of a small caliber aorta with extra-anatomical revascularization of the lower extremities may be considered a useful treatment alternative for an aortoenteric fistula in severely unstable or compromised patients, either as a bridge to open surgery or as a definitive treatment if signs of reinfection do not occur.