Aortoduodenal fistula after endovascular stent-graft of an abdominal aortic aneurysm Bertrand Janne d'Othée, MD, Philippe Soula, MD, Philippe Otal, MD,

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Presentation transcript:

Aortoduodenal fistula after endovascular stent-graft of an abdominal aortic aneurysm Bertrand Janne d'Othée, MD, Philippe Soula, MD, Philippe Otal, MD, Maurice Cahill, MD, Francis Joffre, MD, Alain Cérène, MD, Hervé Rousseau, MD Journal of Vascular Surgery Volume 31, Issue 1, Pages 190-195 (January 2000) DOI: 10.1016/S0741-5214(00)70081-4 Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 End-procedure arteriogram shows intentional positioning of upper extremity of the stent-graft just below the superior mesenteric artery ostium, because kidneys were considered nonfunctional in this patient, who has been undergoing long-term hemodialysis. Peripheral calcifications outline the aneurysmal sac. The upper neck is long, and proximal anchoring appears adequate. Journal of Vascular Surgery 2000 31, 190-195DOI: (10.1016/S0741-5214(00)70081-4) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Axial CT slices obtained 1 month (above ) and 22 months (below ) after stent-grafting procedure. Both views are taken at the same level, demonstrating the enlargement of the upper neck of the aneurysm after stent-grafting. No migration or rupture of the metallic structure of the device is observed. Journal of Vascular Surgery 2000 31, 190-195DOI: (10.1016/S0741-5214(00)70081-4) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Early arterial phase of urgent CT examination performed 22 months after stent-grafting. Enhanced stent-graft lumen extends beyond the outer limit of the calcified aneurysmal sac. Journal of Vascular Surgery 2000 31, 190-195DOI: (10.1016/S0741-5214(00)70081-4) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Plain abdominal roentgenography performed at urgent admission, 22 months after the initial stent-grafting. Most of the metallic structure of the stent-graft has migrated distally into the aneurysmal sac (big arrow ). A small portion of the upper extremity of the device (small upper arrow ) remains attached to the aortic wall at the proximal anchoring site. The left leg of the device (small left arrow ) is in front of the left aspect of the aneurysmal sac. Journal of Vascular Surgery 2000 31, 190-195DOI: (10.1016/S0741-5214(00)70081-4) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Operative view of the ulcerated duodenum (reclined cranially). The textile portion of the stent-graft left leg (at the bottom of the ulcer) was the only element still separating the aortic lumen from the duodenal lumen. Journal of Vascular Surgery 2000 31, 190-195DOI: (10.1016/S0741-5214(00)70081-4) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Ex vivo roentgenograms obtained after surgical explantation of the device shows fractures of the metallic structure and rupture of the suture threads at the proximal end of the prosthesis. Journal of Vascular Surgery 2000 31, 190-195DOI: (10.1016/S0741-5214(00)70081-4) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions