Abstract
Circuits of abdominal arteries to adjoining lumenal organs, especially in triggering circumstances, are rare diseases that are increasingly evident in endovascular therapies and complex viscero-/tumor-surgical procedures with subsequent lengthy adjuvant therapies. Their care is a challenge and involves frequent complications and mortality. Narrative overview on the basis of current scientific references and our clinical and surgical experience. Uretero-arterial fistulas are usually associated with recurrent and intermittent gross haematuria. The diagnostic test of choice continues to be angiography with the potential for endovascular therapy, which has displaced open surgical procedures due to minimal invasiveness, low morbidity and mortality. Aorto-oesophageal fistulas may result from underlying infectious and malignant diseases as well as open and endovascular therapies of the aorta. Multi-line contrast CT of the thorax/abdomen and gastroscopy have priority in diagnostic testing. Endovascular procedures can only be understood as bridging procedures, and only the removal of prostheses with aortic and gastrointestinal reconstruction are curative. Aorto-enteric fistulas are secondary complications of open and endovascular aortic surgery. Contrast enhanced multi-line CT has high sensitivity and specificity. In contrast, open surgical therapy involves in-situ reconstruction of extra-anatomical reconstructions with aortic ligature. Endovascular therapy is reserved for exceptional cases. Inflammatory aneurysms of visceral arteries may be associated with adjacent inflammatory processes, most commonly pseudoaneurysms. The most suitable diagnostic procedure is contrast-enhanced thin-film CT angiography. The treatment of choice is endovascular ablation using covered stents or embolisation. Arterio-visceral/arterio-lumenal fistulas are similar in pathogenesis, predisposing factors and clinical symptoms. An interdisciplinary consultation is employed to identify individualised therapy. Endovascular/interventional procedures are safe and effective, and open surgical rehabilitation is mostly curative.
Published Version
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