The overall outcome of aortoduodenal syndrome following endovascular vs open surgical interventions

Abstract

ObjectiveAortoduodenal syndrome (ADS) is a direct compression of an abdominal aortic aneurysm against the superior mesenteric artery or the abdominal wall, causing mechanical bowel obstruction. The first such case was reported by Canadian Professor William Osler in 1905. This clinical condition is mainly treated surgically to relieve the obstruction either by open aneurysm repair or gastrointestinal bypasses and, recently, by endovascular interventions. This systematic review aimed to assess the outcomes of different interventions in terms of symptomatic improvement thoroughly, peri- and post-intervention aneurysmal size, and overall survival rates. MethodsGoogle Scholar, Pubmed, and the Cochrane Library databases were searched by two independent reviewers to collect case reports and short case series on aortodudenal syndrome written in English and published from January 2000 to July 2023. ResultsThis review was conducted on 28 articles published from 2001 to 2023, with a total of 30 cases included. The mean age of the patients was 73.76 ± 7.7 years; nausea and vomiting (97%), abdominal pain (73%), abdominal distention (63%) were the most common symptoms among presentation. Twenty-four patients (80%) had comorbidities; only 7 of them were known to have abdominal aortic aneurysm. The aneurysmal sac at presentation ranged from 3.8 to 11.0 cm, with a mean size of 7.2 ± 2.2 cm. Eleven patients (36.7%) underwent endovascular aortic repair (EVAR), and 17 patients (56.7%) had open aortic repair, and 2 patients (6.6%) had a gastrointestinal bypass, either gastrojejunostomy or Roux-en-Y gastric bypass. The size of the aneurysmal sac was reported for eight patients who underwent EVAR ranging from 3.8 to 11.0 cm with a mean size of 7.27 ± 2.65 cm before the intervention; after the intervention, the mean size was 6.48 ± 2.26 cm. Mortality was reported in two patients; one underwent gastrojejunostomy and the other underwent EVAR. ConclusionsAortoduodenal syndrome remains a rare condition; the choice of surgical intervention is affected by patient factors, surgeon experience, and resource availability. That necessitates tailoring a management plan for each patient.