A Case of Bridged Therapy with Emergency Endovascular Aortic Repair (eEVAR) for Aorto-Duodenal Fistula

Abstract

Aorto-Duodenal Fistula (ADF) is a critical disease in which aorta communicates with duodenum as causing massive gastrointestinal hemorrhage or hemorrhagic shock, and it eventually results in a high rate of death if left untreated. The case is for male at the age of 62 and vomited blood at the previous medical institution. He was diagnosed as ADF in upper gastrointestinal endoscopy and contrast-enhanced CT scan. The patient was transferred to our institution after Intra-Aortic Balloon Occlusion (IABO) was inserted by a radiologist at the previous medical institution. We performed emergency Endovascular Aortic Repair (eEVAR). Later, we also performed stent graft removal, blood vessel prosthesis implantation, and partial duodenectomy. Revascularization can be a principle for the treatment of ADF, but since hemostasis by EVAR has been recently reported in some cases, it was considered that our case was successfully treated with bridged therapy.