Palliative treatment of a secondary aortoduodenal fistula by stent-graft placement

A 64-year-old mate was admitted with suspected aortoduodenal fistula 16 yea rs after transabdominal aortic reconstruction for aortoiliac occlusive dise ase. Computed tomography (CT) and angiography revealed an aortoduodenal fis tula and a sutureline aneurysm at the proximal anastomosis. Due to the pati ent's poor general condition at the time of diagnosis, endoluminal stent-gr aft implantation was chosen rather than conventional surgery. Successful pl acement of the stent graft without leakage of contrast medium and with comp lete exclusion of the fistula was demonstrated by CT. The patient recovered uneventfully and was discharged 10 days after the intervention. Five month s later contrast CT indicated a recurrence of the aortoduodenal fistula. Si nce the patient was now in good general condition the stent graft was remov ed surgically and an extra-anatomic axillofemoral bypass was implanted. End oluminal stent-graft Implantation is effective as palliative therapy for ao rtoduodenal fistulas and is especially valuable in patients with high risk for conventional surgery.