%0 Journal Article
%T Aortoenteric Fistula as a Complication of Open Reconstruction and Endovascular Repair of Abdominal Aorta
%A Marek Tagowski
%A Hendryk Vieweg
%A Christian Wissgott
%A Reimer Andresen
%J Radiology Research and Practice
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/383159
%X The paper intends to present a review of imaging characteristics of secondary aortoenteric fistula (AEF). Mechanical injury, infection, and adherence of a bowel segment to the aorta or aortic graft are major etiologic factors of AEF after open aortic repair. The pathogenesis of AEF formation after endovascular abdominal aortic repair is related to mechanical failure of the stent-graft, to stent graft infection, and to persistent pressurization of the aneurysmal sac. The major clinical manifestations of AEF comprise haematemesis, melaena, abdominal pain, sepsis, and fever. CT is the initial diagnostic modality of choice in a stable patient. However, the majority of reported CT appearances are not specific. In case of equivocal CT scans and clinical suspicion of AEF, scintigraphy, 67Ga citrate scans or 18F-FDG PET/CT is useful. Diagnostic accuracy of endoscopy in evaluation of AEF is low; nevertheless it allows to evaluate other than AEF etiologies of gastrointestinal bleeding. Without adequate therapy, AEF is lethal. Conventional surgical treatment is associated with high morbidity and mortality. The endovascular repair may be an option in hemodynamically unstable and high-risk surgical patients. We also illustrate an example of a secondary AEF with highly specific albeit rare radiologic picture from our institution. 1. Introduction Secondary aortoenteric fistula (AEF) is a rare but potentially lethal complication of aortic surgery first reported by Brock in 1953. This currently better-known pathology still poses considerable diagnostic difficulties due to its unspecific clinical and radiologic manifestations. The aim of this paper is to present the current diagnostic approach to secondary AEF taking into account its complex and heterogeneous pathogenesis as a cause of the broad spectrum of its radiologic manifestations. For a better understanding of the subject, we commence the paper by presenting a secondary AEF with highly specific albeit rare radiologic picture from our institution. A 73-year-old man was referred to our emergency department with severe hematemesis and melena, suggestive of gastrointestinal bleeding. Low blood pressure and tachycardia indicated circulatory shock; laboratory results revealed anemia and elevated inflammatory markers (leukocytes 16.8/nL, CRP 14.5£¿mg/dL). In the medical history it was noted that he survived a covered perforation of an abdominal aortic aneurysm 2 months earlier. The incident was treated in another hospital with an open surgical approach, using a rifampicin-soaked Dacron Y-prosthesis. No complications
%U http://www.hindawi.com/journals/rrp/2014/383159/