Aortoenteric fistula after endovascular abdominal aortic aneurysm treatment with the original Gore Excluder endoprosthesis and Cook aortouniiliac converter for endotension

Abstract

We report a case of aortoenteric fistula (AEF) that occurred four years after endovascular abdominal aortic aneurysm repair (EVAR) with the original Gore Excluder endoprosthesis despite uncomplicated stent graft placement without endoleaks or migration on postoperative imaging studies; the patient was reoperated with a Cook aortouniiliac converter for endotension three months before the diagnosis of AEF. To our knowledge, this is the first reported case in the literature of an AEF after EVAR with the Excluder stent graft. Our case demonstrates that EVAR is not a guarantee against the development of AEF, and we suggest that all the patients with the first generation Excluder device should be closely followed-up; if sac enlargement is detected, early conversion to open repair or reinforcement of the entire old endograft should be considered.