Endovascular repair of a presumed aortoenteric fistula: Late failure due to recurrent infection

Purpose: To describe a case of presumed aortoduodenal fistula that was trea ted by endovascular implantation of a stent-graft. Methods and Results: A 76-year-old man was transferred from another hospita l where he had been treated for upper gastrointestinal hemorrhage over a a- month period. Ten years previously he had undergone aortobifemoral bypass, the right limb of which recently thrombosed. At the time of transfer, compu ted tomographic scanning showed a large false aneurysm between the aorta an d the duodenum. Endoscopy disclosed mucosal erosions in the fourth portion of the duodenum. Following implantation of 2 overlapping stent-grafts, the bleeding ceased and the false aneurysm disappeared. At no time did the pati ent have a fever. The patient initially did well, but 8 months after treatm ent, he presented with fever and chills. Recurrent infection had caused ero sion of the aorta so that a large portion of the stent-graft was visible fr om the duodenum. The infected graft and stent-grafts were removed in a two- part operation, from which the patient recovered satisfactorily. Conclusions: Endovascular stent-grafts may have a role to play in the manag ement of aortoduodenal fistula, if only as a temporary measure to control b leeding.