Abstract
An aortoduodenal fistula (ADF) is a well-documented clinical entity associated with serious complications such as infections and massive bleeding. An ADF rarely occurs after endovascular aneurysm repair (EVAR). We present the case of a 76-year-old woman who underwent EVAR for an abdominal aortic aneurysm with an angulated neck ; however, she showed persistence of a type II endoleak. She developed septic discitis and an iliopsoas abscess 10 months after EVAR and was treated with antibiotics. She developed an ADF 1 year postoperatively, presented with hematemesis and tarry stools, and was diagnosed following an esophagogastroduodenoscopic examination. Stent grafts were implanted along the angulated neck anatomically, which caused kinking of the device in the aneurysmal sac with subsequent erosion of the stent graft limb into the duodenum through the aneurysmal wall. Ulcerations were found on adjacent portions of both, the aneurysmal sac and the third portion of the duodenum. These could have resulted from the preceding infection, persistent endoleak, and/or mechanical erosion. The patient was successfully treated by performing a duodenojejunal bypass, in-situ partial replacement and repositioning of the kinked stent graft limb, and omental interposition and did not show recurrent fistulae or infections. We emphasize the need for strict monitoring to avoid the risk of ADF formation following EVAR.
