www.elsevier.com/locate/semvascsurg Available online at www.sciencedirect.com Current status of endovascular treatment of aortoenteric fistula Konstantinos Spanos, George Kouvelos, Christos Karathanos, Miltiadis Matsagkas, and Athanasios D. Giannoukas n Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41334 Larissa, Greece article info abstract Aortoenteric fistula (AEF) is one of the most challenging diagnostic and therapeutic entities in vascular surgery. AEF can occur either primarily involving the aorta and the gastro- intestinal tract or, more commonly, secondary to previous aortic reconstructive surgery. Traditionally, the treatment of AEF includes graft excision and extra-anatomic bypass surgery or in situ graft replacement. However, recently endovascular repair has emerged as an alternative therapeutic option. In this article, we present published and current evidence for endovascular repair of primary and secondary AEF. When endovascular treatment is applied where appropriate, early outcomes seem to be superior compared to open surgery. This benefit may be lost during long-term follow-up, implying that a staged approach with early conversion to in situ grafting may realize the best patient survival and morbidity. Lifelong administration of antibiotics is associated with a reduction in re- infection. An endovascular approach used as a bridging procedure in unstable patients is recommended, followed by definitive open therapy, if feasible, in patients with good life expectancy. & 2017 Elsevier Inc. All rights reserved. 1. Introduction Aorto-enteric fistula (AEF) is defined as an abnormal con- nection between the aorta and the gastrointestinal tract. It is the result of either a primary process involving the aorta and the gastrointestinal tract or secondary to aortic interventions after the erosion of an aortic prosthetic graft into the surrounding gastrointestinal structures [1–3]. In the primary AEF, communication develops between the aorta (commonly aneurysmatic) and the intestinal lumen. This communication most frequently occurs between the infrarenal aorta and the third or fourth portion of the duodenum (in 83% of patients), as these structures are closely related to each other, especially in the presence of an abdominal aortic aneurysm; 20% of the remaining AEFs occur with the small bowel or the colon and 5% with the stomach or a combination of various intestinal sites [1,2,4]. In extremely rare cases, primary AEF can develop after endovascular aortic aneurysm repair due to type II endoleak [5]. Secondary AEF occurs after previous open aortic surgery and is the communication between the synthetic graft used for aortic reconstruction and the intestinal lumen [1,2]. The third portion of the duodenum is the most vulnerable bowel segment to vascular impingement because of its retroperito- neal fixation and proximity to the aorta. The process origi- nates from the ischemia and the subsequent necrosis of the http://dx.doi.org/10.1053/j.semvascsurg.2017.10.004 0895-7967/$ - see front matter & 2017 Elsevier Inc. All rights reserved. n Corresponding author. E-mail addresses: agiannoukas@hotmail.com; giannouk@med.uth.gr (A.D. Giannoukas). S EMINARS IN V ASCULAR S URGERY 30(2017) 80 – 84