Fatal Case of a Contained Ruptured of the Infrarenal Aorta due to Simultaneous Primary Aortocaval Fistula and Aortoenteric Fistula
Tóm tắt
We report an extremely rare case of primary aortocaval fistula with simultaneous development of an aortoenteric fistula in a 68-year-old man. The patient developed under oral anticoagulation a spontaneous intracaval aortic rupture. An emergency intervention was performed with a covering of the fistula with an aorto-uniiliac stent graft and a femoro-femoral crossover bypass. One week later, the patient was transferred to our institution with the diagnosis of a psoas abscess and a suspected concomitant aortoenteric fistula. We performed a complete explantation of the endograft and implanted it after extensive debridement an aortobiiliac bypass, made of bovine pericardium. The postoperative course was complicated, first by bleeding from the left iliac anastomosis, and then by bleeding from the proximal aortic anastomosis. The entire graft was explanted and an axillo-femoral bypass was implanted. The patient then developed a multi-organ failure and died 3 months later. If possible, an extended surgical debridement and resection of all infected tissue with in situ reconstruction is the gold standard. However, with this therapy, there is still a high risk of reinfection. Long-term antibiotic management is mandatory.
Từ khóa
Tài liệu tham khảo
Brightwell RE, Pegna V, Boyne N (2013) Aortocaval fistula: current management strategies. ANZ J Surg 83:31–35
Maeda H, Umezawa H, Goshima M et al (2007) Surgery for ruptured abdominal aortic aneurysm with an aortocaval and iliac vein fistula. Surg Today 37:445–448
Orion KC, Beaulieu RJ, Black JH 3rd (2016) Aortocaval fistula: is endovascular repair the preferred solution? Ann Vasc Surg 31:221–228
Murphy EH, Szeto WY, Herdrich BJ, Jackson BM, Wang GJ, Bavaria JE et al (2013) The management of endograft infections following endovascular thoracic and abdominal aneurysm repair. J Vasc Surg 58:1179–1185
Kuestner LM, Reilly LM, Jicha DL, Ehrenfeld WK, Goldstone J, Stoney RJ (1995) Secondary aortoenteric fistula: contemporary outcome with use of extraanatomic bypass and infected graft excision. Vasc Surg 21:184–195 (discussion: 195-6)
Kahlberg A, Rinaldi E, Piffaretti G, MAEFISTO collaborators et al (2016) Results from the multicenter study on aortoenteric fistulization after stent grafting of the abdominal aorta (MAEFISTO). J Vasc Surg 64(2):313–320
Ranasinghe W, Loa J, Allaf N, Guney D (2011) Primary aortoenteric fistulae: the challenges in diagnosis and review of treatment. Ann Vasc Surg 25:386