Fístula aortoentérica tratada y resuelta con abordaje híbrido endovascular y abierto

Abstract

Aorto-enteric fistula is a rare entity with high mortality, occasionally surgically treated. Classically, the proposed treatment is open surgical repair with a Dacron prosthetic graft and intestinal resection in the same act. Given the poor results, in recent years some cases of endovascular treatment with stent implantation have been described.

We present a case of an aortoenteric fistula resolved by a hybrid approach through stent implantation and intestinal resection with fistulaa sealing by open surgery in a second stage. This is a 75-year-old male patient who was admitted to our hospital with symptoms of acute aortic syndrome. The CT aortogram revealed a known abdominal aortic aneurysm of 8.4 × 8.4 × 9.5 cm and a vascular luz of 5 × 3.4 cm with signs of periaortic fat infiltration suggesting luz rupture vs. aortoenteric fistula. Given the hemodynamic instability of the patient, the team decided on emergent EVAR implantation with intestinal resection surgery in a second stage. The endoprosthesis was implanted without initial incidents but a resealing had to be performed due to endoleak in the subsequent control CT aortogram. In a second stage, the team performed the intestinal resection and closure of the fistula. The patient recovered favorably and was discharged.

The hybrid open and endovascular approach in complex pathologies with high mortality, such as aortoenteric fistula, may offer an alternative approach in patients with high morbidity.