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Aortoenteric Fistula: A Late Complication of Endovascular Repair of an Inflammatory Abdominal Aortic Aneurysm

Vascular Medicine, Division of Cardiology, Department of Medicine, Columbia University Medical Center, 161 Ft Washington Ave, Suite 533, New York, NY 10032; eh483{at}columbia.edu

Nicholas J. Morrissey, MD

Division of Vascular Surgery, Columbia University Medical Center, New York, New York

Endovascular repair provides a reasonable alternative to open repair for the treatment of abdominal aortic aneurysms in select cases. Although the endovascular approach may be preferable for inflammatory aneurysms, aggressive surveillance is needed to monitor for long-term complications. A 61-year-old man underwent endovascular exclusion of a symptomatic inflammatory abdominal aortic aneurysm with an AneuRx bifurcated aortic prosthesis. He presented with gastrointestinal bleeding 51/2 months later and was found to have an aortoenteric fistula involving the third portion of the duodenum. The aneurysm had expanded significantly at the proximal neck. The patient underwent successful removal of the device, aortic ligation, and extraanatomic bypass. Aortoenteric fistula is a rare but now established complication of endovascular aneurysm repair. The pathophysiology in these cases remains unclear. The presence of inflammation and endoleak may predispose to further aneurysmal degeneration.

Key Words: aortoenteric fistula • inflammatory abdominal aortic aneurysm • endovascular aneurysm repair

Vascular and Endovascular Surgery, Vol. 40, No. 6, 487-491 (2007)
DOI: 10.1177/1538574406294076


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