Our Surgical Strategy in a Patient Developing Aortoduodenal Fistula after Six Months from Aortobifemoral Bypass

Kazim Ergunes, Yuksel Besir, Levent Yilik, Ismail Yurekli, Orhan Gokalp, Koksal Donmez, Utkan Tunca, Ali Gurbuz

Izmir Katip Celebi University Ataturk Training and Research Hospital, İZMİR, Turkey

Date, time and location: 2018.05.26 13:30, Exhibition area, 1st Floor. Zone – B

Abstract

Objective: Secondary aortoduodenal fistula is relatively rare but dangerous complication of abdominal aort reconstructive surgery. We present a patient patients developing aortoduodenal fistula after six months from aortobifemoral bypass.

Methods: The patient was a 52 –year-old man who complained of melena. He underwent a aortobifemoral bypass surgery 6 months ago. He vital signs were recorded as pulse rate 114 beats per minute regular, respiratory rate 18 breahts per minute, and blood pressure 100/60 mmHg. There wwre a median linear scar on his abdomen and inguinal regions scars showing previous abdominal surgery. His past surgical records revealed aortobifemoral graft due to Lerich syndrome.The upper gastrointestinal endoscopy showed aortoduodenal fistula. The computed tomography scan with contrast showed abdominal mass and aortoduodenal fistula.

Results: On exploratory laparatomy, we found hematomas around the duodenum adhered to the omentum. The proximal part of the abdominal aorta was occluded a balon. Blood clotes were removed and the fistula identified. Prosthetic graft was separated from abdominal aorta and common femoral arteries. The aorta was repaired primer suture. A extra-anatomic axillo-bifemoral bypass was performed 8 mm polytetrafluoroethylene graft. The duodenum was repaired primarily by general surgery surgeon.

Conclussions: . A extra-anatomic axillo-bifemoral bypass grafting is a effective surgical treatment method in patients developing aortoduodenal fistula after from aortobifemoral bypass