Endovascular Repair of a Bleeding Secondary Aortoenteric Fistula with Acute Leg Ischemia: a Case Report and Review of the Literature

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The endovascular approach seems very attractive for patients with bleeding secondary aortoenteric fistulas (SAEF) and limb ischemia, particularly when there is no associated sepsis. Aortic stent-grafting can rapidly seal the aortoenteric communication and ensure limb reperfusion. In the present case, a 53-year-old man with a bleeding SAEF and acute leg ischemia underwent aortic stent-grafting. Ten months later, CT and leukocyte scan (Tc-99m) showed no evidence of graft infection and the patient remains well 18 months postoperatively. In the typical patient with a bleeding SAEF, endoluminal treatment, if feasible anatomically, should be considered as first-choice treatment whether it represents a “bridging” step or a “definite” solution.

Section snippets

CASE REPORT

At this institution, no approval of the Institutional Review Board is required for case reports. A 53-year-old man with a history of aortobifemoral bypass for aortoiliac occlusive disease 9 years ago was being investigated at another institution for a recent history of easy fatigue when he experienced acute left leg ischemia. The patient was air-transferred to our hospital. On admission, he was afebrile, with a blood pressure of 115/80 mm Hg and a heart rate of 80 beats/minute, and was

DISCUSSION

In general, patients with SAEF are typical “vascular patients” with many comorbidities. These comorbidities together with acute hemorrhage in a patient with a hostile abdomen (due to previous laparotomy) place them in the high-risk category for an open surgical procedure. When limb ischemia is added, then two major risks have to be taken into consideration: the first one is the possibility of sudden exsanguination (if patient is not already in shock) and the second one is the prolongation of

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