title: Use of Aortic Occluders and Endovascular Plugs in a 2-step Hybrid Treatment of Secondary Aortoenteric Fistulas.
abstract: Aortoenteric fistula (AEF) is a dreadful complication of abdominal aortic surgery. Surgical treatment is associated to high mortality and requires urgent graft removal with extra-anatomic or in situ reconstruction. Other authors suggest the use of stent grafts, both as a stand-alone procedure or as a bridge solution before open repair. We reviewed the results of a cohort of patients that presented at our institution with an AEF and were treated with a novel 2-step endovascular-open surgical procedure. The first step consisted in immediate endovascular occlusion of the infrarenal graft with deployment, below the renal arteries, of an aortic occluder and/or endovascular plugs. After occlusion of the infrarenal graft, extra-anatomic reconstruction (axillofemoral bypass) was performed. The second step consisted in the removal of the infrarenal graft with aortic stump ligation and took place after a few days recovery to allow improvement of patients' condition. A total of 5 selected patients were treated. Endovascular aortic occlusion was achieved in all cases with the deployment of 1 (3 patients) or 2 (2 patients) devices. The mean interval between the first and the second step was 7 days (min 4-max 13). Complete removal of the aortic graft was possible in all patients. One patient died on the first postoperative day due to multiorgan failure (1 of 5, 20%). Mean survival after discharge was 24 months (min 6-max 36). One patient died at 6 months because of aortic stump blowout. In our initial experience, endovascular aortic occlusion seems an effective option to prevent fatal enteric bleeding and a valuable first-step treatment for selected cases of AEF.
authors.affiliation: Department of Vascular Surgery, Nuovo Ospedale Civile S. Agostino-Estense, University of Modena and Reggio Emilia, Baggiovara, Modena, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Silingardi
authors.affiliation: Department of Vascular Surgery, Nuovo Ospedale Civile S. Agostino-Estense, University of Modena and Reggio Emilia, Baggiovara, Modena, Italy. Electronic address: giovanni.coppi@gmail.com.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Coppi
authors.affiliation: Department of Vascular Surgery, Nuovo Ospedale Civile S. Agostino-Estense, University of Modena and Reggio Emilia, Baggiovara, Modena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Saitta
authors.affiliation: Department of Vascular Surgery, Nuovo Ospedale Civile S. Agostino-Estense, University of Modena and Reggio Emilia, Baggiovara, Modena, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lauricella
authors.affiliation: Department of Vascular Surgery, Nuovo Ospedale Civile S. Agostino-Estense, University of Modena and Reggio Emilia, Baggiovara, Modena, Italy.
authors.forename: Mistral Klend
authors.initials: MK
authors.lastname: Njila
authors.affiliation: Department of Vascular Surgery, Nuovo Ospedale Civile S. Agostino-Estense, University of Modena and Reggio Emilia, Baggiovara, Modena, Italy.
authors.forename: Gioachino
authors.initials: G
authors.lastname: Coppi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D020878:Device Removal; D057510:Endovascular Procedures; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D016157:Vascular Fistula / Q000209:etiology / Q000601:surgery*