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Emergent Endovascular Treatment in Primary Ilio-enteric Fistula.
- Source :
-
Annals of vascular surgery [Ann Vasc Surg] 2020 Feb; Vol. 63, pp. 455.e17-455.e21. Date of Electronic Publication: 2019 Oct 14. - Publication Year :
- 2020
-
Abstract
- Aortoenteric fistula (AEF) is a rare cause of gastrointestinal (GI) bleeding. If not promptly diagnosed and treated, the associated mortality is very high. The role of endovascular treatment is not yet defined. In this article, we report a clinical case of a 94-year-old male patient admitted in the emergency department with rectal bleeding. Owing to the detection of a pulsatile abdominal mass, a computed tomography angiography (CTA) scan was performed, which established the diagnosis of aorto-enteric fistula due to a left common iliac artery aneurysm (CIAA) ruptured to the sigmoid colon and also revealed an abdominal aortic aneurysm (AAA) and an internal iliac artery aneurysm (IIAA). Given the age of the patient, general condition and technical difficulty inherent to the treatment of the IIAA by conventional surgery, we chose endovascular treatment. However, we wanted to avoid contact between the endograft and the colon orifice because of the risk of infection. The patient was treated emergently with an aorto-right uni-iliac graft and a femoro-femoral bypass, IIAA embolization and 2 left iliac excluders (at the origin of the common iliac and distally in the external iliac artery). It was decided to treat colon lesion conservatively. In this case, the aorto-uni-iliac graft excluded the aortic inline flow, the distal occluder prevented retrograde flow from the external iliac, and the embolization prevented retrograde flow and treated the IIAA. This way, no arterial pressure and no prosthetic material existed inside the ruptured artery, hopefully allowing the spontaneous closing of the orifice leading the sigmoid colon to heal. The postoperative period was uneventful, and the patient was discharged at the 8 <superscript>th</superscript> postoperative day. The patient outcome is a strong argument on the merit of the treatment strategy.<br /> (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged, 80 and over
Emergencies
Humans
Iliac Aneurysm diagnostic imaging
Iliac Aneurysm physiopathology
Iliac Artery diagnostic imaging
Iliac Artery physiopathology
Intestinal Fistula diagnostic imaging
Intestinal Fistula physiopathology
Male
Sigmoid Diseases diagnostic imaging
Sigmoid Diseases physiopathology
Treatment Outcome
Vascular Fistula diagnostic imaging
Vascular Fistula physiopathology
Blood Vessel Prosthesis Implantation
Embolization, Therapeutic
Endovascular Procedures
Iliac Aneurysm surgery
Iliac Artery surgery
Intestinal Fistula surgery
Sigmoid Diseases surgery
Vascular Fistula surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1615-5947
- Volume :
- 63
- Database :
- MEDLINE
- Journal :
- Annals of vascular surgery
- Publication Type :
- Report
- Accession number :
- 31622766
- Full Text :
- https://doi.org/10.1016/j.avsg.2019.07.016