Aortoduodenal Fistulas After Endovascular Stent-Graft Repair of Abdominal Aortic Aneurysms: Single-Center Experience and Review of the Literature

作者：Saratzis Nikolaos^*; Saratzis Athanasios; Melas Nikolaos; Ktenidis Kyriakos; Kiskinis Dimitrios

来源：Journal of Endovascular Therapy, 2008, 15(4): 441-448.

DOI：10.1583/08-2377.1

• abdominal aortic aneurysm
• endovascular aneurysm repair
• aortoduodenal fistula
• complication
• infection
• mortality

Purpose: To report a single-center experience with aortoduodenal fistula (ADF) after successful endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm (AAA).
Methods: Five patients (all men; mean age 68.4 years, range 60-75) developed an ADF between 18 days to 1 year after successful EVAR using 3 types of commercially available endografts: 1 bifurcated Anaconda, 1 unibody Powerlink, and 3 EndoFit stent-grafts in a tubular (n=1) or aortomonoiliac configuration (n=2). The internal iliac artery was not occluded in any of the cases.
Results: Hematemesis and diffuse abdominal pain constituted the main symptoms leading to the diagnosis of ADF, which was confirmed on computed tomography. Infection was the etiology of the AN in 3 patients; all underwent emergency surgical exploration, but 1 died in hospital; the other 2 have survived from 1 to 3 years after an emergency procedure. The other 2 ADFs developed in patients with large type I endoleaks; 1 patient died before surgery could be performed and the other one 18 hours after laparotomy. All stent-grafts were removed; none displayed any defects.
Conclusion: ADF is a rare but dangerous complication of EVAR. The sequela may be primarily attributed to graft infection, as seen in this series. However, the exact pathogenesis of the pathology remains largely unknown. Prompt diagnosis and intervention are crucial to avoid a fatal outcome. J Endovasc Ther 2008;15:441-448

• 出版日期2008-8