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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2013 December;26(6):419-23
Endovascular treatment of an acute aortoenteric fistula with combination endograft placement, detachable coils and an Amplatzer vascular plug
Stambo G. W., Berlet M., Woeste T., Van Epps K., Valentin M.
SDI Radiologist’s St Joseph’s Hospital and Baptist Medical Center, Department of Vascular and Interventional Radiology Tampa, FL, USA
Secondary aortoenteric fistula (AEF) is a well-documented complication of open abdominal aortic aneurysm repair. It is an uncommon devastating complication following aortic repair that is a highly fatal vascular emergency. The classic clinical triad includes a pulsating abdominal mass, gastrointestinal bleeding and abdominal pain. The diagnosis requires a high level of clinical suspicion. Commuted tomography (CT) has become the diagnostic modality of choice even more accurate than endoscopy. CT findings of a peri-graft infection along with acute gastrointestinal bleeding; AEF should be diagnosed. Surgical repair has a high morbidity and mortality from 25-90%. Life threatening exsanguinations presenting as acute gastrointestinal bleeding can occur through the aortoenteric fistula. Gastrointestinal bleeding is the most common manifestation of AEF occurring approximately 64-100%. This is the first article describing the use of a combination of multiple endovascular techniques in the treatment of a secondary aortoenteric fistula. A combination of percutaneous endografts, GDC and an Amplatzer vascular plug were used to treat this entity. These techniques were successful in rapidly and effectively treating this serious condition without open surgical repair. Endovascular specialists should be aware of the use of these devices and techniques in the rapid treatment of this rare but lethal complication of abdominal aortic reconstructive surgery.