Emergency CTA Diagnosis and Successful Endovascular Management of Aorto-duodenal Fistula

Aorto-enteric fistula is defined as a communication between the aorta and the gastrointestinal tract. It is a rare but life-threatening condition associated with almost 100% mortality without prompt surgical intervention. The most common type of aorto-enteric fistula is the aorto-duodenal fistula. Upper gastrointestinal bleeding is the most common presentation, ranging from a minor haemorrhage to massive life-threatening bleeding. Computed tomography angiography is the first-line modality for imaging evaluation of suspected aorto-enteric fistula. Surgical treatment of this condition may be open aortic repair, in situ graft replacement if present, or placement of an extra-anatomical bypass. We present our case of a 71-year-old woman with infected aorto-aortic graft complicated by aorto-duodenal fistula. The patient was successfully treated by aortic Zenith Cook cuff endovascular placement in the emergency setting as a life-saving treatment and a bridge solution to elective surgery.