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Regarding the Case Report from Elise Beijer, et al. Published in Volume 55, 2022; Vascular Forum. “Endovascular Treatment of Aortic Stump Rupture after Extra-anatomic Aortoduodenal Fistula Repair is not a Definitive Treatment: A Case Report and Literature Review”
Dear Editor and Author, I read carefully your report and congratulations on the nice description and highly skilled treatment. As we all know, vascular graft infections are devastating complications accompanied by high mortality and morbidity rates. The endovascular solution is used either as a bridging or definitive treatment. In the real world, the bridging option becomes a definite solution due to difficulties with open surgery and a high mortality rate. There is limited literature available and as you noted usually case reports.
I draw your attention to the published paper in 2014 by my colleagues and me, “S Duvnjak, P E Andersen, K E Larsen, O Roeder. Endovascular repair of post-operative vascular graft related complications after aorto-iliac surgery. Int Angiol2014 Aug; 33 (4):386–91”.
In this paper, we had a case with aortoduodenal fistula and blind aortic stump bleeding complications treated with Amplatz plug and left renal chimney stent due to the position of the left renal artery and risk of occlusion if the Amplatz plug was used without renal protection. The patient had undergone a few abdominal operations previously and endovascular treatment was desirable and became the definitive solution, lasting almost two years without a new bleeding complication. The patient died due to a new bleeding episode almost two years after the treatment. The early follow up CT showed a well deployed Amplatz and open left chimney stent.
The devastating aortoenteric fistula complications require an individual approach, and endovascular options have a remarkable role in the treatment of those patients either as a temporary or permanent solution.
S Duvnjak, P E Andersen, K E Larsen, O Roeder. Endovascular repair of postoperative vascular graft related complications after aorto-iliac surgery. Int Angiol 2014 Aug; 33 (4):386–391.
We would like to thank S Duvnjak et al. for their comments. In our case report,1 we elaborated on a complicated case in which the patient developed vascular graft infection years after endovascular repair of an acutely bleeding aortic stump. We stated that in such cases the endovascular salvage repair should be followed by a more definitive treatment when the patient is fit for surgery, especially for of aortoduodenal fistula cases. However, we also expressed our thoughts on patients who are unfit for surgery; they may well benefit from a more conservative approach with culture based antibiotic therapy, making this second best treatment option a reasonable alternative.
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