Palliative treatment of a secondary aortoduodenal fistula by stent-graft placement

A 64-year-old male was admitted with suspected aortoduodenal fistula 16 years after transabdominal aortic reconstruction for aortoiliac occlusive disease. Computed tomography (CT) and angiography revealed an aortoduodenal fistula and a suture-line aneurysm at the proximal anastomosis. Due to the patient's poor general condition at the time of diagnosis, endoluminal stent-graft implantation was chosen rather than conventional surgery. Successful placement of the stent graft without leakage of contrast medium and with complete exclusion of the fistula was demonstrated by CT. The patient recovered uneventfully and was discharged 10 days after the intervention. Five months later contrast CT indicated a recurrence of the aortoduodenal fistula. Since the patient was now in good general condition the stent graft was removed surgically and an extra-anatomic axillofemoral bypass was implanted. Endoluminal stent-graft Implantation is effective as palliative therapy for aortoduodenal fistulas and is especially valuable in patients with high risk for conventional surgery.