Treatment of secondary aortoenteric fistula after endovascular repair of abdominal aortic aneu-rysm

Abstract

Objective To summarize our experience in the treatment of secondary aortoenteric fistula (AEF) after endovascular repair of abdominal aortic aneurysm. Methods The data of six patients with secondary AEF enrolled in our hospital from January 2000 to December 2014 were retrospectively analyzed. The male to female ratio was 5∶1, with an average age of (66.7±6.7) years (58 to 77 years). Four patients had once received endovascular aorta repair (EVAR), while 2 received open surgery, for abdominal aortic aneurysms. The chief complaint was repeated fever for 1 to 27 months after previous operation. Only three patients were accurately diagnosed as secondary AEF for herald hemorrhage or signs of graft invasion of the on CT scan. Other 3 patients were diagnosed as prosthesis infection on admission, of whom two patients refused re-operation. In total 4 patients received extra-anatomic bypass, prosthesis excision and intestine repair. Postopratively one patient with simultaneous aorto-vesical fistula received bladder repair as well. Results The AEF located at the third portion of duodenum in 2 patients, at upper or middle part of jejunum in 3 patients and at middle ileum in 1 patient. The two patients who gave up died within 2 months, while the other four patients who received re-operation recovered uneventfully. During 3 to 48 months follow-up, 1 bypass occlusion occurred without severe lower extremity ischemia. No other serious complications were observed. Conclusions Secondary AEF is a rare but fatal complication after open or endovascular repair of abdominal aortic aneurysm. Extra-anatomic bypass and excision of the contaminated prosthesis is a reliable management. Key words: Aortic aneurysm, abdominal; Intestinal fistula; Coronary artery bypass