Endovascular repair of a primary aortoenteric fistula with staged open aortoplasty and omentopexy with duodenal repair

Primary aortoenteric fistulas (AEFs) are rare and life-threatening. We report the successful hybrid management of a 60-year-old man who presented in hemorrhagic shock from a primary aortoduodenal fistula arising from an unsuspected abdominal aortic aneurysm. The patient underwent emergent endovascular aneurysm repair (EVAR) followed by early, staged open aortoplasty and duodenal repair with omental flap reinforcement two days later. This case illustrates the successful use of a non-traditional approach to management of a primary AEF in an unstable patient. Few reports describing this technique have been found in the literature.