Surgical Management for Secondary Aortoduodenal Fistula

Aortoenteric fistulas (AEFs) are uncommon but life-threatening conditions carrying a high mortality rate. This is defined as an abnormal connection between the aorta and the lumen of the gastrointestinal tract. There are two known forms of AEF, primary and secondary. Primary is most often the result of compression of an abdominal aortic aneurysm against the intestines, whereas secondary is due to an erosion of an aortic prosthetic graft into the surrounding gastrointestinal structures. The relative incidence of primary AEF ranges from 0.1 to 0.8%, and secondary from 0.4% to 2.4%. Mortality rates after surgical treatment of secondary AEFs range from 14% to 70%. This report describes the surgical approach of a secondary aortoduodendal fistula after placement of end to side aortobifemoral bypass for claudication symptoms in a 58-year-old female presenting with gram-negative bacteremia.