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Online ISSN 1827-1847
De Lutiis F. 2, Palmieri A. 1, Di Cosmo I. 2, Magnacca F. 1, Fiore F. 1, Ucchino S. 2, Spigonardo F. 1
1 Department of Cardiovascular Diseases, Vascular and Endovascular Surgery Unit, “S.S. Annunziata”, Hospital Chieti, Italy
2 Vascular Surgery Specialization School, University of Chieti, Chieti, Italy
Aortoenteric fistula (AEF) is likely to be rare after endovascular aneurysm repair (EVAR) and has only recently been described in the literature as a result of mechanical stent failure, migration or infection. We report a case of aortoenteric fistula occurred five years after endovascular abdominal aortic aneurysm repair. A 77-year-old man received an Excluder stent-graft for endovascular repair of a 6-cm infrarenal abdominal aortic aneurysm. Five years postoperatively the patient has developed fever and an elevated white blood cell count, VES and PCR; he underwent a six-week course of intravenous antibiotics. A contrast tomography scan of the abdomen and pelvis revealed air around the aortic stent-graft. The patient was treated with primary duodenal repair, removal of the infected graft, in situ placement of a bifurcated silver-graft, and omental interposition. Cultures of periaortic fluid were positive for Staphilococcus simulans and Enterococcus fecalis. He died 10 days later for sepsis and multiorgan failure. In our case fistulization occurred despite accurate stent-graft placement without migration, endoleak, or aortic sac size enlargement on annual postoperative imaging studies. Due to the increasing use of endovascular techniques, we emphasize the need for vigilance about the risk of AEF in case of an endovascular approach.