Partially Covered Transjugular Intrahepatic Portosystemic Shunt Endograft for Repair of a Primary Aortoenteric Fistula

Abstract

Aortoenteric fistulae (AEF) are a rare cause of life-threatening gastrointestinal hemorrhage. AEF are divided into primary and secondary types. Secondary fistulae are more common and occur after prior aortic interventions, namely aneurysm repairs. Less common is primary aortoenteric fistulae (PAEF), which most commonly arise de novo from trauma or underlying neoplastic, infectious, or rheumatologic conditions. Although PAEF are associated with high mortality and morbidity, there have been several case reports documenting temporization of PAEF with stent grafts. These measures are effective in acute settings, often with unstable patients. This approach also provides time for the patient, family and their care team to decide on definitive treatment. This is especially important as many of these patients have serious underlying pathology, or will need to undergo extensive treatment for definitive care. Here, we present a case of PAEF in a patent with Stage IV renal malignancy. The bleed was controlled with the use of a 12 mm VIATORR endoprosthesis (W. L. Gore and Associates, Inc., Flagstaff, Arizona, USA), typically used in transjugular intrahepatic portosystemic shunts. The report demonstrates how an endoprosthesis originally designed for hepatic interventions can serve as an endovascular stent graft in extenuating circumstances. This report also aims to highlight the importance of following endovascular principles and the post-treatment care of patients with PAEF.