Secondary Aorto-enteric Fistula and Type II Endoleak Five Years after Endovascular Abdominal Aortic Aneurysm Repair
Introduction: Secondary aorto-enteric fistula (AEF) after endovascular abdominal aortic aneurysm repair (EVAR) is a rare but potentially fatal disease. The aetiology and mechanisms are unclear. This study presents a patient who developed secondary AEF and type II endoleak five years after EVAR. Case...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-01-01
|
| Series: | EJVES Short Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405655319300131 |
| _version_ | 1818156775149404160 |
|---|---|
| author | Yojiro Koda Hirohisa Murakami Masato Yoshida Hitoshi Matsuda Nobuhiko Mukohara |
| author_facet | Yojiro Koda Hirohisa Murakami Masato Yoshida Hitoshi Matsuda Nobuhiko Mukohara |
| author_sort | Yojiro Koda |
| collection | DOAJ |
| description | Introduction: Secondary aorto-enteric fistula (AEF) after endovascular abdominal aortic aneurysm repair (EVAR) is a rare but potentially fatal disease. The aetiology and mechanisms are unclear. This study presents a patient who developed secondary AEF and type II endoleak five years after EVAR. Case: A 73 year old man underwent successful EVAR with a bifurcated aortic stent graft for a 5.5 cm infrarenal abdominal aortic aneurysm. The aneurysm sac showed no change in size for three years, then shrank 20 mm to 3.5 cm by five years. After five years and eight months, the patient presented with fever and back pain. Enhanced CT demonstrated enlargement of the aneurysm sac, type II endoleak from the third and fourth right lumbar arteries, and air around the stent graft. An emergency operation was performed. The infected stent graft was removed by pushing up the stent graft to release the hooks from the wall of the aorta. A small fistula resembling a fish mouth measuring 1×1 cm was observed in the third part of the duodenum. The fistula was closed by direct suture, and in situ reconstruction was performed with an 18×9 mm standard polyethylene terephthalate graft. Culture of the explanted stent graft grew enterobacter. Intravenous antibiotic therapy was continued for six weeks and was stopped after confirming no recurrence of infection with computed tomography and laboratory testing. Two years later, there has been no recurrence of infection. Conclusion: Long term surveillance is critical because AEF can occur even after initially successful EVAR. Keywords: Endovascular abdominal aortic aneurysm repair, Secondary aorto-enteric fistula, Type II endoleak |
| first_indexed | 2024-12-11T15:03:39Z |
| format | Article |
| id | doaj.art-864ee323838f4a8fbff5c983945a81c6 |
| institution | Directory Open Access Journal |
| issn | 2405-6553 |
| language | English |
| last_indexed | 2024-12-11T15:03:39Z |
| publishDate | 2019-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EJVES Short Reports |
| spelling | doaj.art-864ee323838f4a8fbff5c983945a81c62022-12-22T01:01:02ZengElsevierEJVES Short Reports2405-65532019-01-01431217Secondary Aorto-enteric Fistula and Type II Endoleak Five Years after Endovascular Abdominal Aortic Aneurysm RepairYojiro Koda0Hirohisa Murakami1Masato Yoshida2Hitoshi Matsuda3Nobuhiko Mukohara4Division of Cardiovascular Surgery, Department of Surgery, Kobe University Hospital, Hyogo, JapanDepartment of Cardiovascular Surgery, Hyogo Brain and Heart Centre, Himeji, JapanDepartment of Cardiovascular Surgery, Hyogo Brain and Heart Centre, Himeji, JapanDepartment of Cardiovascular Surgery, National Cerebral and Cardiovascular Centre, Suita, Japan; Corresponding author. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Centre, 5–7-1 Fujishirodai, Suita, Osaka, 565–8565, Japan.Department of Cardiovascular Surgery, Hyogo Brain and Heart Centre, Himeji, JapanIntroduction: Secondary aorto-enteric fistula (AEF) after endovascular abdominal aortic aneurysm repair (EVAR) is a rare but potentially fatal disease. The aetiology and mechanisms are unclear. This study presents a patient who developed secondary AEF and type II endoleak five years after EVAR. Case: A 73 year old man underwent successful EVAR with a bifurcated aortic stent graft for a 5.5 cm infrarenal abdominal aortic aneurysm. The aneurysm sac showed no change in size for three years, then shrank 20 mm to 3.5 cm by five years. After five years and eight months, the patient presented with fever and back pain. Enhanced CT demonstrated enlargement of the aneurysm sac, type II endoleak from the third and fourth right lumbar arteries, and air around the stent graft. An emergency operation was performed. The infected stent graft was removed by pushing up the stent graft to release the hooks from the wall of the aorta. A small fistula resembling a fish mouth measuring 1×1 cm was observed in the third part of the duodenum. The fistula was closed by direct suture, and in situ reconstruction was performed with an 18×9 mm standard polyethylene terephthalate graft. Culture of the explanted stent graft grew enterobacter. Intravenous antibiotic therapy was continued for six weeks and was stopped after confirming no recurrence of infection with computed tomography and laboratory testing. Two years later, there has been no recurrence of infection. Conclusion: Long term surveillance is critical because AEF can occur even after initially successful EVAR. Keywords: Endovascular abdominal aortic aneurysm repair, Secondary aorto-enteric fistula, Type II endoleakhttp://www.sciencedirect.com/science/article/pii/S2405655319300131 |
| spellingShingle | Yojiro Koda Hirohisa Murakami Masato Yoshida Hitoshi Matsuda Nobuhiko Mukohara Secondary Aorto-enteric Fistula and Type II Endoleak Five Years after Endovascular Abdominal Aortic Aneurysm Repair EJVES Short Reports |
| title | Secondary Aorto-enteric Fistula and Type II Endoleak Five Years after Endovascular Abdominal Aortic Aneurysm Repair |
| title_full | Secondary Aorto-enteric Fistula and Type II Endoleak Five Years after Endovascular Abdominal Aortic Aneurysm Repair |
| title_fullStr | Secondary Aorto-enteric Fistula and Type II Endoleak Five Years after Endovascular Abdominal Aortic Aneurysm Repair |
| title_full_unstemmed | Secondary Aorto-enteric Fistula and Type II Endoleak Five Years after Endovascular Abdominal Aortic Aneurysm Repair |
| title_short | Secondary Aorto-enteric Fistula and Type II Endoleak Five Years after Endovascular Abdominal Aortic Aneurysm Repair |
| title_sort | secondary aorto enteric fistula and type ii endoleak five years after endovascular abdominal aortic aneurysm repair |
| url | http://www.sciencedirect.com/science/article/pii/S2405655319300131 |
| work_keys_str_mv | AT yojirokoda secondaryaortoentericfistulaandtypeiiendoleakfiveyearsafterendovascularabdominalaorticaneurysmrepair AT hirohisamurakami secondaryaortoentericfistulaandtypeiiendoleakfiveyearsafterendovascularabdominalaorticaneurysmrepair AT masatoyoshida secondaryaortoentericfistulaandtypeiiendoleakfiveyearsafterendovascularabdominalaorticaneurysmrepair AT hitoshimatsuda secondaryaortoentericfistulaandtypeiiendoleakfiveyearsafterendovascularabdominalaorticaneurysmrepair AT nobuhikomukohara secondaryaortoentericfistulaandtypeiiendoleakfiveyearsafterendovascularabdominalaorticaneurysmrepair |