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Published on: August 1, 2025
Endovascular treatment of two aortoduodenal fistulae
Susana Cancer Pérez1, Fernando Criado Galán, Enrique Puras Mallagray
1Department of Vascular Surgery, Hospital Universitario Fundación Alcorcón, C/ Budapest 1, Alcorcón, Madrid, Spain. scancer@fhalcorcon.es
Insights
Endovascular repair offers a vital treatment for aortoduodenal fistulae, particularly in high-risk patients. This minimally invasive approach can be a life-saving alternative when open surgery is not feasible.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Interventional Radiology
Background:
- Aortoduodenal fistulae are rare but life-threatening complications, often associated with abdominal aortic aneurysms and previous aortic surgery.
- Traditional open surgical repair carries significant risks, especially in patients with comorbidities.
Observation:
- Two patients with aortoduodenal fistulae underwent endovascular repair.
- The first patient, with a history of mycotic abdominal aortic aneurysm repair, presented with hematemesis and was successfully treated.
- The second patient, with severe COPD, underwent endovascular repair for an abdominal aortic pseudoaneurysm and aortoduodenal fistula but succumbed to postoperative pneumonia.
Findings:
- Endovascular aortic repair was technically successful in both cases.
- The first patient remained asymptomatic at 27 months post-procedure, highlighting the durability of the repair.
- The second patient's outcome underscores the challenges in managing complex cases with significant comorbidities.
Implications:
- Endovascular repair is a crucial option for aortoduodenal fistulae, offering a less invasive alternative to open surgery.
- This approach is particularly valuable for patients with high surgical risk due to comorbidities.
- Careful patient selection and management are essential for optimizing outcomes in endovascular aortic repair.
Abstract:
We report the endovascular treatment of two patients presenting with aortoduodenal fistulae. The first patient was a 66-year-old man admitted with hematemesis. He was on clopidogrel and had received a cryopreserved aortic graft for a mycotic abdominal aortic aneurysm five years earlier. Computed tomography (CT) showed aortic pseudoaneurysms in close contact with the duodenum. Endovascular repair was carried out. Twenty-seven months after the procedure the patient remains asymptomatic. The second patient was a 78-year-old man admitted with abdominal pain and nausea. CT revealed an abdominal aortic pseudoaneurysm and aortoduodenal fistula. He suffered from severe chronic obstructive pulmonary disease that greatly increased his surgical morbidity and mortality. An endovascular repair was performed under epidural anesthesia. The patient died of a postoperative pneumonia 38 days after surgery. These two cases illustrate the importance of endovascular aortic repair especially when an open surgical procedure is either difficult or impossible.
