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Temporary endovascular control of a bleeding aortoenteric fistula by transcatheter coil embolization
Christos D Karkos1, Paraskevi A Vlachou, Paul D Hayes
1Departments of Vascular & Endovascular Surgery, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom. ckarkos@hotmail.com
Insights
A patient with gastrointestinal bleeding due to an aortic stump fistula underwent successful coil embolization. This endovascular technique provided a temporary solution, allowing for future treatment planning.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Aortic graft infection can lead to rare but serious complications.
- Fistula formation between the aortic stump and duodenum presents a significant management challenge.
Observation:
- A 67-year-old male presented with gastrointestinal bleeding 14 months post-axillobifemoral bypass, graft excision, and aortic stump closure.
- The bleeding was caused by a fistula between the aortic stump and the fourth part of the duodenum.
- The patient initially declined definitive surgical intervention.
Findings:
- Coil embolization of the aortic stump was successfully performed via a brachial approach.
- This endovascular procedure effectively managed the gastrointestinal bleeding.
Implications:
- Coil embolization serves as a valuable adjunct for managing complex aortic stump fistulas.
- This technique can provide crucial time for planning definitive treatment.
- It offers a palliative option for patients unsuitable for major surgery.
Abstract:
A 67-year-old man presented with gastrointestinal bleeding resulting from a fistula between the aortic stump and the fourth part of the duodenum 14 months after an axillobifemoral bypass, graft excision, and aortic stump closure for aortic graft infection. The patient initially refused any attempt at definitive surgical treatment so coil embolization of the aortic stump was performed via a brachial approach. Coil embolization may be a useful adjunct in the management of such difficult problems. This approach may buy time and allow careful planning of a definitive treatment or may serve as a palliative procedure in inoperable patients.
