Cooper Medical School of Rowan University, Camden, NJ, USA.
Deparement of Vascular and Endovascular Surgery, Cooper University Hospital, Division of Vascular Surgery, Camden, NJ, USA.
Vascular. 2024 Apr;32(2):296-299. doi: 10.1177/17085381221140950. Epub 2022 Nov 17.
We present a case of a 59-year-old male with an actively bleeding aortoenteric fistula (AEF) that was temporized using an endovascular stent prior to staged open reconstruction.
Verbal informed consent was given by the patient's family for publication of this case report. The patient presented with pulseless electrical activity secondary to hemorrhagic shock due to a massive gastrointestinal bleed. His past surgical history included an aortobifemoral bypass (ABFB) that subsequently underwent extra-anatomic reconstruction with right axillofemoral artery bypass for right femoral infected pseudoaneurysm. Two months prior to presentation, he underwent a second revision with in-situ reconstruction for left limb graft infection. CTA now demonstrated actively bleeding AEF. He was emergently treated with endovascular stenting. Once stabilized, a two-stage revision with extra-anatomic bypass and aortic stump closure for management of his AEF was performed.
The patient was adequately stabilized using endovascular techniques followed by two-stage revision but unfortunately expired secondary to septic shock 20 days postoperatively.
This case highlights the utility of endovascular stent graft to successfully obtain hemodynamic stability and optimization prior to open repair of AEFs.
我们报告 1 例 59 岁男性患者，其主动出血性肠-动脉瘘（AEF）在分期开放重建前使用血管内支架暂时处理。
患者家属同意发表此病例报告，患者因大量胃肠道出血导致失血性休克出现无脉电活动。他的既往手术史包括主动脉-股动脉旁路移植术（ABFB），随后因右股动脉感染性假性动脉瘤进行了右腋股动脉旁路的解剖外重建。在出现症状前 2 个月，他因左侧肢体移植物感染进行了第二次修正原位重建。现在 CTA 显示主动出血性 AEF。他紧急接受了血管内支架治疗。一旦稳定，进行了两阶段修正，包括解剖外旁路和主动脉残端闭合，以治疗他的 AEF。
患者使用血管内技术成功获得血流动力学稳定和优化，随后进行两阶段修正，但不幸的是，术后 20 天因感染性休克去世。
本病例强调了血管内支架在成功获得血流动力学稳定和优化，然后进行开放修复 AEF 的过程中的作用。
