title: Emergent endovascular treatment of a bleeding recurrent aortoenteric fistula as a "bridge" to definitive surgical repair.
abstract: We report the case of a 59-year-old man who developed a recurrent aortoenteric fistula (AEF) following previous aorto-bifemoral bypass grafting and subsequent AEF open repair with aorto-bifemoral graft excision and extra-anatomic reconstruction. The patient was treated emergently by means of endovascular plug deployment via a left brachial approach into the infrarenal aortic stump, obtaining recovery of hemodynamic stability. Five days later, he underwent elective relaparotomy, aortic plug removal, infrarenal aortic ligature, and duodenal repair. Endovascular strategies to rapidly stop bleeding associated with recurrent AEF may serve as a "bridge" to definitive open repair, as in the case discussed herein. Even if rare, recurrent AEF following previous prosthetic aortic graft excision and extra-anatomic revascularization represents a dreadful event. Since surgical treatment is technically demanding and time consuming in emergent settings, we present an "unconventional" endovascular option to obtain quick cessation of aortic bleeding.
authors: Division of Vascular Surgery, "Vita-Salute" University, San Raffaele Scientific Institute, Milan, Italy.
authors: Enrico Maria
authors: EM
authors: Marone
authors: Daniele
authors: D
authors: Mascia
authors: Andrea
authors: A
authors: Kahlberg
authors: Yamume
authors: Y
authors: Tshomba
authors: Roberto
authors: R
authors: Chiesa
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D021721:Balloon Occlusion / Q000295:instrumentation* / Q000379:methods; D003131:Combined Modality Therapy; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D018570:Risk Assessment; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000150:complications / Q000628:therapy*; D014656:Vascular Surgical Procedures / Q000379:methods*