Aorto-enteric Fistula 15 Years After Uncomplicated Endovascular Aortic Repair with Unforeseen Onset of Endocarditis.

INTRODUCTION: Aorto-enteric fistula after endovascular aortic repair is an exceedingly rare but serious condition. REPORT: A rare case of a fistula between the excluded aortic sac and the transverse colon 15 years after endovascular aortic repair is described. Onset was endocarditis without gastrointestinal haemorrhage, migration, endoleak, or aortic sac dilatation. The patient was successfully treated by fistula excision, debridement and broad spectrum antibiotic treatment without endograft explantation. DISCUSSION: Aorto-enteric fistula can emerge after endovascular repair with an unforeseen onset such as endocarditis, which in this case probably occurred as metastatic sepsis from endograft infection.

In-situ bypass surgery on arteriographically invisible vessels detected by Doppler-ultrasound for limb salvage.

AIM: The aim of this paper was to evaluate our primary experience with bypass surgery on arteries only visible on Doppler-ultrasound in patients suffering from critical lower limb ischemia. METHODS: During a study period of 10 months, Doppler-ultrasound routinely supplemented digital subtraction arteriography (DSA) whenever it failed to reveal patent runoff vessels suitable for in-situ saphenous vein bypass surgery. If an arteriographically invisible runoff artery was detected on Doppler-ultrasound and the patient was eligible for surgery, a bypass procedure was performed. All patients were facing a lower limb amputation due to critical limb ischemia (tissue loss, SVS/ISCV-category 5). Postoperatively the patients were followed according to a standard graft surveillance program, including clinical examination, ankle pressure measurements and a color Doppler-ultrasound at discharge and after 1, 6 and 12 months. RESULTS: Fifty-one in-situ saphenous vein bypasses were performed, 5 (10%) on arteriographically occult runoff vessels detected only on Doppler-ultrasound. After a 12-month follow-up, 3 bypasses were still patent and only one patient had an amputation. One bypass occluded after 6 months but the patient stayed asymptomatic. CONCLUSIONS: Doppler-ultrasound permits in-situ by-pass surgery on arteriographically invisible vessels reducing the proportion of inoperable patients by 10%.