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Aortoenteric Fistula And Type III Endoleak As Late Complication Of EVAR

Thursday, 22 September, 2011 - 12:30
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AORTOENTERIC FISTULA AND TYPE III ENDOLEAK AS LATE COMPLICATION OF EVAR

Martinez Gallego, E.L.1, Ruiz Diaz, E.2, Rielo Arias, F.J.1, Pulpeiro Ríos, J.R.2, Gegúndez Gómez, C.3, Conde Vales, J.3, Pérez Carballo, E.1, Durán Mariño, J.L.1, García Colodro, J.M.1  

1. Department of Vascular Surgery. 2. Department of Interventional Radiology.

3. Department of General Surgery. Lucus Augusti Hospital. SERGAS. Lugo. Spain.

 

Secondary aortoenteric fistula (AEF) have been recently described in patients that has had interventions to insert aortic endografts to treat aortoiliac aneurysms. The incidence seems to be lower that in open surgery and some authors have postulated that these AEFs appears after migration of the devices or endoleaks.

A 77 years old man went to the emergency unit for abdominal pain and important rectorragy, needing blood transfusion.

As relevant medical problems presents an abdominal inflammatory aortic aneurysm treated with an aorto-biiliac Vanguard stent graft in 1999, and a posterior repair in 2002, with a Zenith aortouniiliac and cross-over femoro-femoral by pass, due to premature failure of  the Vanguard graft.

An abdominal duplex scan shows a 10cm AAA with important turbulence into the aneurismatic sac, and graft patency. The CT examination reveals the inflamatory aortic aneurysm with visceral branches involvement; secondary bilateral hidronefrosis due to ureteral obstruction for retroperitoneal fibrosis. The occluded branch of the first endograft seems to be very near to the posterior wall of the 3rd duodenal portion. A big  endoleak is evidenced, aparently due to an arterial lession by the aortouniiliac device

The gastroscopy, done to complete the diagnostic, shows an strange body in the duodenal wall without active bleeding in the lumen.

An emergency arteriography shows a type III distal endoleak, due to Vanguard fabric disruption. A laborious repair of the endoleak is performed, extending the left branch to  the hipogastric bifurcation.

The intervention is completed by 3rd and 4th duodenal portion resection with a duodeno-yeyunal anastomosis, finding a important duodenal inflamation, calcificated wall aneurysm adhesion, and duodenal microperforation signs. Finally, the aneurysm was covered with omentum.

The postoperatory underwent without complications, and an abdominal duplex scan  and CT confirms the absence of leaks into the aneurysmatic sac.

 

Part of Session

Vascular Surgery

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