Primary aortoduodenal fistula complicated by abdominal aortic aneurysm

A 74-year-old male patient was operated in Vakif Gureba Hospital for aortoduodenal fistula developing from abdominal aortic aneurysm. The patient was diagnosed as abdominal aortic aneurysm after physical examination and computed tomography in another center. Appearing of melena and hematemesis gastroduodenoscopy and radionuclide scanning was performed as diagnosis. After 6 days gastrointestinal bleeding recurred in massive haemorrhage and the patient was operated with a diagnosis of aortoenteric fistula as emergency. A midline laparotomy was performed. There was a fistula between infrarenal abdominal aortic aneurysm (with diameter 8x10 cm) and the 3rd portion of the duodenum. The duodenum was resected segmental and the fistula was disconnected. Following aneurysmotomy a prosthetic graft was placed in the aortobiiliac position. The patient was discharged at the 42nd postoperative day. Primary aortoenteric fistula is a very rare consequence of untreated abdominal aortic aneurysm. The segments of intestine most frequently involved in aortoenteric fistula are the 3rd and 4th portions of the duodenum. Clinical presentation is recurrent episodes of gross gastrointestinal haemorrhage. These cases have high mortality and morbidity unless evaluated as quickly as possible and appropriate surgical intervention performed.     

Primary aortoduodenal fistula caused by duodenal tuberculosis without an abdominal aortic aneurysm: Report of a case

A 66-year-old man died of massive gastrointestinal hemorrhage caused by a fistula between the third portion of the duodenum and the abdominal aorta. An autopsy revealed that duodenal tuberculosis had resulted in the development of a fistula into the aorta with no pathological changes, and no active pulmonary tuberculosis was found. Duodenal tuberculosis and primary aortoduodenal fistula (ADF) without an aneurysm are both extremely rare. Thus, we report herein a unique case of primary aortoduodenal fistula without an abdominal aortic aneurysm, but associated with duodenal tuberculosis, and review the current literature.     

Abdominal aneurysm with aortoduodenal fistula

Two patients having the abdominal aneurysm with aortoduodenal fistula were treated surgically, but graft infection occurred. One patient died about 6 months after and the other about one year after the operation due to massive hemorrhage from the postoperative aortointestinal fistula. The difficulties in the treatment of the aortoduodenal fistula were discussed.     

Endovascular repair and pharmacotherapy of an inflammatory abdominal aortic aneurysm complicated by primary aortoduodenal fistula

An inflammatory abdominal aortic aneurysm complicated by primary aortoduodenal fistula was successfully treated by stent grafting. Pharmacotherapy with octreotide after endovascular aneurysm repair was also performed with the expectation of spontaneous and rapid closure of the fistula. Gastrointestinal endoscopy performed 10 days after endovascular aneurysm repair showed closure of the large aortoduodenal fistula, and oral intake was started on the operative day 16. To date, 16 months after the initial operation, the patient is doing well without any symptoms or signs of infection and without any antibiotic therapy.     

Endovascular abdominal aortic aneurysm repair in a patient with Ehlers-Danlos syndrome

Ehlers-Danlos syndrome is a connective tissue disorder caused by abnormal collagen synthesis. Vascular complications, including aneurysm formation and spontaneous arterial perforations, are difficult to manage surgically and result in significant operative mortality due to blood vessel fragility. We describe the first reported successful endovascular abdominal aortic aneurysm repair in a patient with Ehlers-Danlos syndrome. We discuss the advantages endovascular surgery offers over open surgery in these patients. We believe that endovascular repair of abdominal aortic aneurysms preferentially over open repair merits consideration in patients with Ehlers-Danlos syndrome.     

Rupture of an abdominal aortic aneurysm with concomitant aorto-caval fistula

Aorto-caval fistulas are one of the most uncommon complications of infrarenal aortic aneurysms and have a high pre and perioperative mortality rates. Its prompt diagnosis and early treatment may be helpful in lowering the surgical morbidity and mortality. One successfully treated case of a ruptured aortic aneurysm with concomitant aorto-caval fistula is reported, discussing the clinical presentation, the diagnosis and the details of the surgical techniques employed.     

Primary aortoduodenal fistula of tuberculous origin

This case of aorto-duodenal fistula was due to fistulization of a tuberculous lymph node between an atheromatous aneurysm of the infra-renal aorta and the third part of the duodenum. CAT scan provided the diagnosis of an aorto-duodenal fistula. The tuberculous origin of the fistula was confirmed by bacteriological and histological examinations. The outcome was favourable after revascularisation "in situ" combined with epiplooplasty and prolonged antituberculous drug therapy.     

Aortic-caval fistula from ruptured abdominal aortic aneurysm.

Four cases of spontaneous aorto-caval fistula are reported. All cases were successfully treated by suture of the fistula from the inside of the aortic aneurysm, which was replaced by a dacron graft. All patients are alive and well at follow up after one, three, four and twelve years, respectively. In one patient pulmonary and circulatory haemodynamics were recorded preoperatively as well as in the early and late postoperative period. Preoperative high pulmonary artery and capillary wedge pressures and cardiac output were rapidly reduced to almost normal values after the operation. An intrapulmonary shunt fraction of 58 % preoperatively was reduced to 15 % shortly after closure of the fistula. Possible mechanisms causing the high pulmonary shunt fraction are discussed.     

Successful repair of sealed-ruptured pararenal abdominal aortic aneurysm with left-sided inferior vena cava employing the technique for thoracoabdominal aortic aneurysm repair

We describe a case with pararenal abdominal aortic aneurysm associated with anomalous inferior vena cava. We applied the technique similar to that employed in the thoracoabdominal aneurysm repair consisting of mild hypothermic cardiopulmonary bypass and selective visceral perfusion. Replacement of the abdominal aorta and reconstruction of the left renal artery were completed without an injury to the anomalous vein.     

Hybrid repair of abdominal aortic aneurysm in a patient with poliomyelitis-related deformities

A 63-year-old man presented with an asymptomatic infrarenal abdominal aortic aneurysm. He had scoliosis and atrophic right leg change as sequelae of poliomyelitis. The patient was not a candidate for endovascular aneurysm repair because of anatomic unsuitability. An open surgical repair was performed by the retroperitoneal approach because of severe scoliosis and left lateral aneurysm deviation. To minimize contralateral exposure, the Viabahn stent graft (W. L. Gore & Associates, Flagstaff, Ariz) was inserted in the right external iliac artery and anastomosed with the right expanded polytetrafluoroethylene graft limb. I report the successful hybrid repair of infrarenal abdominal aortic aneurysm using the modified Viabahn open revascularization technique.     

Congenital factor VII deficiency in a patient with an abdominal aortic aneurysm

A patient with congenital factor VII deficiency underwent surgery for an inflammatory abdominal aortic aneurysm. No references in the literature have been found on the management of this coagulation defect in patients who require vascular surgery. We present one such case, with special reference to the perioperative management of factor VII replacement therapy. (J Vasc Surg 1996;24:288-90.)     

Open stent grafting for abdominal aortic aneurysm in a patient with a severely calcified abdominal aorta

We describe a 74-year-old male who underwent open stent repair for an infrarenal abdominal aortic aneurysm with a severely calcified aortic neck. The stent graft was constructed by covering a 50-mm long Gianturco Z stent (diameter: 20 mm) with a Dacron prosthesis (diameter: 20 mm). The stented Dacron graft was inserted into the calcified aortic neck, was then sutured to the trimmed aneurysmal wall, and was anastomosed to a bifurcated prosthesis. The distal ends of the bifurcated prosthesis were anastomosed to both common femoral arteries, and the terminal aorta was closed. The patient had an uneventful postoperative course. This procedure may be a feasible and safe way to repair infrarenal abdominal aortic aneurysm with a severely calcified aortic neck.     

Ruptured abdominal aortic aneurysm with fistula into the right iliac vein

Arteriovenous fistula between major abdominal vessels is an unusual complication of ruptured abdominal aortic aneurysm. It most frequently occurs between the aorta and the inferior vena cava, however, it is rare when occurring between the aorta and iliac veins. A case of an arteriovenous fistula (AVF), secondary to erosion of an arteriosclerotic abdominal aortic aneurysm into both the retroperitoneum and the iliac vein is presented. The literature is reviewed and the symptoms and the treatment are discussed.     

Thoracoabdominal aortic aneurysm associated with abdominal aortic and visceral arterial occlusion in a hemodialysis patient

We report an extremely rare case of saccular thoracoabdominal aortic aneurysm associated with high abdominal aortic occlusion including the superior mesenteric and bilateral renal arteries in a patient requiring hemodialysis. Successful repair of the aneurysm and concomitant revascularization of the lower extremities was achieved using femoro-femoral bypass for perfusion of the lower body along with the visceral and intercostal arteries.     

Ruptured abdominal aortic aneurysm in the elderly patient

The authors discuss several aspects of the management of ruptured abdominal aortic aneurysm in elderly patients. The cost-effectiveness and indications of repair of rAAA in elderly patients are analysed. A literature survey of risk-factors and results of open treatment of rAAA in elderly patients is made. The challenge of endovascular repair of rAAA in the elderly patient is discussed. Finally, the authors report their personnal experience with AAA repair in 163 patients aged 75 years and older, operated on between January 2003 and September 2005(89 endoaneurysmal stentgrafts and 74 open repairs, 42 rAAA,23 symptomatic AAA and 98 selective asymptomatic AAA).