DOI: 10.25881/20728255_2021_16_3_89

Authors

Kranin D.L., Zhuravlev A.G., Svergunenko S.S., Zamskiy K.S., Petrov K.Yu.

Chief military clinical hospital named after academic N.N. Burdenko, Moscow

Abstract

Infectious complications after EVAR (endovascular aortic repair) develop in 1% of the total cases of device implantations for atherosclerotic aneurysm of the abdominal aorta.

Aortoenteric fistula is a rare and extremely dangerous complication of abdominal aortic reconstructive surgery, associated with high mortality if untreated.

This article describes a clinical case of infection after EVAR with formed aorto-duodenal fistula in a comorbid patient, an algorithm for choosing a technique and the process of surgical treatment.

In clinical case describedes possible options for surgical treatment and management tactics for patients with infection after EVAR, considered modern literary sources.

Keywords: EVAR, endoprosthesis infection, aorto-intestinal fistula, EVAR infection.

References

1. Alekjan BG, Pokrovskij AV, Karapetjan NG, Revishvili ASh. Sovremennye tendencii razvitija hirurgicheskogo i jendovaskuljarnogo lechenija bol’nyh s arterial’noj patologiej. Angiologija i sosudistaja hirurgija. 2019; 4: 55-62. (In Russ).

2. Galkin PA, Svetlikov AV. Results of endovascular aneurysm repair of infrarenal aorta and iliac arteries in patients with severe concomitant diseases. Grekov’s Bulletin of Surgery. 2018; 177(5): 11-16. (In Russ). doi: 10.24884/0042-4625-2018-177-5-11-16.

3. Mjerin M, Vejt F, Parodi Dzh. Jendoprotezy dlja lechenija arterial’nyh zabolevanij. Angiologija i sosudistaja hirurgija. 1995; 1: 44-56. (In Russ).

4. Veretenin V.A. Perioperacionnye i otdalennye oslozhnenija rentgenjendovaskuljarnogo protezirovanija pri anevrizmah brjushnoj aorty. Kriterii otbora pacientov dlja jendoprotezirovanija. Vestnik Nacional’nogo mediko-hirurgicheskogo Centra im. N.I. Pirogova. 2007: 65-69. (In Russ).

5. Hobbs SD, Kumar S, Gilling-Smith GL. Epidemiology and diagnosis of endograft infection. J Cardiovasc Surg (Torino). 2010; 51: 5-14.

6. Lyons OT. A 14-year experience with aortic endograft infection: Management and results. European Journal of Vascular and Endovascular Surgery. 2013; 3(46): 306-313.

7. Kahlberg A, Rinaldi E, Piffaretti G, Speziale F, et al. MAEFISTO collaborators. Results from the Multicenter Study on Aortoenteric Fistulization After Stent Grafting of the Abdominal Aorta (MAEFISTO). J Vasc Surg. 2016; 64(2): 313-320.

8. Batt M, Feugier P, Camou F, Coffy A, et al. A meta-analysis of outcomes after in situ reconstructions for aortic graft infection. Angiology. 2018; 69: 370-379.

9. Moulakakis KG, Sfyroeras GS, Mylonas SN, Mantas G, et al. Antonopoulos CN, Kakisis JD, Liapis CD. Outcome after preservation of infected abdominal aortic endografts. J Endovasc Ther. 2014; 21(3): 448-55.

10. Cernohorsky P, Reijnen MM, Tielliu IF, van Sterkenburg SM, van den Dungen JJ, Zeebregts CJ. The relevance of aortic endograft prosthetic infection. J Vasc Surg. 2011; 54(2): 327-33.

11. Chaufour X, Gaudric J, Goueffic Y, Khodja RH, et al. A multicenter experience with infected abdominal aortic endograft explantation. Journal of Vascular Surgery. 2017.

12. Li HL, Chan YC, Cheng SW. Current Evidence on Management of Aortic Stent-graft Infection: A Systematic Review and Meta-Analysis. Ann Vasc Surg. 2018; 51: 306-313.

13. Capoccia L, Speziale F, Menna D, Esposito A, et al. Collaborators. Preliminary Results from a National Enquiry of Infection in Abdominal Aortic Endovascular Repair (Registry of Infection in EVAR-R.I.EVAR). Ann Vasc Surg. 2016; 30: 198-204.

14. Lyons OT, Baguneid M, Barwick TD, Bell RE, et al. Diagnosis of Aortic Graft Infection: A Case Definition by the Management of Aortic Graft Infection Collaboration (MAGIC). Eur J Vasc Endovasc Surg. 2016; 52(6): 758-763.

15. Shukuzawa, Ohki, Maeda, Kanaoka Y. Risk factors and treatment outcomes for stent graft infection after endovascular aortic aneurysm repair. J Vasc Surg. 2019; 70(1): 181-192. doi: 10.1016/j.jvs.2018.10.062.

16. Kakkos SK, Bicknell CD, Tsolakis IA, Bergqvist D. Hellenic Choice Management of secondary aorto-enteric and other abdominal arterio-enteric fistulas: a review and pooled data analysis. Eur J Vasc Endovasc Surg. 2016; 52: 770-786.

17. Smeds MR, Duncan AA, Harlander-Locke MP, Lawrence PF, et al. Vascular Low-Frequency Disease Consortium. Treatment and outcomes of aortic endograft infection. J Vasc Surg. 2016; 63: 332-340.

18. Zatevahin II, Matjushkin AV. Oslozhnennye anevrizmy abdominal’noj aorty. M.: Littera. 2010. 208 р. (In Russ).

19. Chakfé N, et al. European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Stent Graft Infections With the Endorsement of the European Association of Nuclear Medicine (EANM). European Journal of Vascular and Endovascular Surgery. 2020.

20. Andrejchuk KA, Soroka VV, Postnov AA, Kagachev PN. s soavt. Pervichnye aorto-kishechnye fistuly. Angiologija i sosudistaja hirurgija. 2012; 18(3): 153-158. (In Russ).

21. Murphy EH, Szeto WY, Herdrich BJ, Jackson BM, et al. The management of endograft infections following endovascular thoracic and abdominal aneurysm repair. J Vasc Surg. 2013; 58: 1179-1185.

22. Hausegger KA, Tiesenhausen K, Karaic R, Tauss J, et al. Aortoduodenal fistula: a late complication of intraluminal exclusion of an infrarenal aortic aneurysm. J Vasc Interv Radiol. 1999; 10: 747-750.

23. Reiner MA, Brau SA, Schanzer H. Primary aortoduodenal fistula. Case presentation and review of literature. Am. J. Gastroenterol. 1978; 70(3): 292-297.

24. Andreychuk KA, Andreychuk NN, Savello VE, Basek IV. Radiologic Diagnosis of Primary Aortic Fistulas. Medical Visualization. 2016; 3:103-110. (In Russ.)

25. Thomson VS, Copinath KG, Joseph E, Joseph G. Primary aorto-enteric fistula: A rare complication of abdominal aortic aneurysm. J. Postgrad. Med. 2009; 55(4): 267-269.

26. Ivashkin VT, Maevskaja MV, Pavlov ChS, Fedos’ina EA. s soavt. Klinicheskie rekomendacii Rossijskogo obshhestva po izucheniju pecheni i Rossijskoj gastrojenterologicheskoj associacii po lecheniju oslozhnenij cirroza pecheni. Ros. zhurn. gastrojenterol., gepatol., koloproktol. 2016; 26(4): 71-102. (In Russ).

27. Garbuzenko DV. Mul’tiorgannye gemodinamicheskie narushenija pri cirroze pecheni. Terapevticheskij arhiv. 2007; 79(2): 73-77. (In Russ).

28. Argyriou C, Georgiadis GS, Lazarides MK, Georgakarakos E, et al. Endograft infection after endovascular abdominal aortic aneurysm repair: a systematic review and meta-analysis. J Endovasc Ther. 2017; 24: 688-697.

29. Fatima J, Duncan AA, de Grandis E, Oderich GS, et al. Treatment strategies and outcomes in patients with infected aortic endografts. J Vasc Surg. 2013; 58: 371-379.

30. Danneels MI, Verhagen HJ, Teijink JA, Cuypers P, Nevelsteen A, et al. Endovascular repair for aorto-enteric fistula: a bridge too far or a bridge to surgery? Eur J Vasc Endovasc Surg. 2006 J; 32(1): 27-33.

31. Batt M, Jean-Baptiste E, O’Connor S, Saint-Lebes B, et al. Early and late results of contemporary management of 37 secondary aortoenteric fistulae. Eur J Vasc Endovasc Surg 2011; 41: 748-757.

32. Rodrigues dos Santos C, Casaca R, Mendes de Almeida JC, Mendes-Pedro L. Enteric repair in aortoduodenal fistulas: a forgotten but often lethal player. Ann Vasc Surg. 2014; 28: 756-762.

For citation

Kranin D.L., Zhuravlev A.G., Svergunenko S.S., Zamskiy K.S., Petrov K.Yu. Aortoenteric fistula after evar in a patient with severe common pathology. Bulletin of Pirogov National Medical & Surgical Center. 2021;16(3):89-95. (In Russ.) https://doi.org/10.25881/20728255_2021_16_3_89