Abstract
Introduction:
Aortoenteric fistula (AEF) following endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) is a rare but severe complication, with most reported cases involving the duodenum, and involvement of the ileum is exceptionally uncommon.
Case presentation:
We report a rare case of secondary aortoileal fistula with concomitant graft infection in a 66-year-old male, occurring two years after EVAR for AAA. The follow-up imaging 2 years after EVAR showed no aneurysmal sac regression, suggestive of a type II endoleak, which was treated with coil embolization. One week post-embolization, the patient presented with abdominal pain and fever, and a secondary aortoileal fistula was diagnosed. The patient underwent bilateral axillofemoral bypass, excision of the AAA and endograft, and intestinal perforation repair. Intraoperative cultures grew Lactobacillus paracasei. The patient recovered uneventfully and remained well at 1-year follow-up.
Conclusion:
Aortoileal fistula after EVAR for AAA is an extremely rare yet potentially fatal complication and should be recognized by both clinicians and patients. It may occur as early as 1 month post-operatively or even more than 10 years after EVAR. Appropriate surgical management should be considered on an individual basis to achieve favorable outcomes.
1 Introduction
Aortoenteric fistula (AEF) is a rare but life-threatening complication and can be classified as primary or secondary AEF. Secondary AEF denotes an AEF that develops after surgical repair of an aortic aneurysm. Most secondary AEFs occur after open abdominal aortic reconstruction (1). AEF following endovascular abdominal aortic aneurysm repair (EVAR) is quite uncommon, with an incidence ranging from approximately 0.26%–3.66% (2–4). The vast majority of fistulas involve the duodenum, whereas those affecting other segments of the small intestine or the colon are exceedingly rare (5). The reported in-hospital mortality rate for patients who developed AEF after EVAR is 22% (4), while the perioperative mortality for those treated with endovascular repair is approximately 37% (6). However, mortality approaches 100% in patients who do not undergo timely or feasible surgical intervention (7, 8).
We report the case of a 66-year-old man who underwent EVAR for an abdominal aortic aneurysm (AAA) and subsequently developed an aortoileal fistula 2 years after the procedure. The fistula occurred in the ileum rather than the more commonly involved duodenum. The patient was treated with axillo-bifemoral bypass, graft explantation, and ileal repair and remained alive at the 1-year follow-up (Figure 1).
Figure 1
2 Case description
On September 12, 2022, a 66-year-old male was found to have an AAA during a health check-up, with no significant presenting symptoms or complaints. Abdominal computed tomography angiography (CTA) showed aneurysmal dilatation of the infrarenal abdominal aortic lumen with a maximum diameter of approximately 77 mm (Figures 2A,B). He subsequently underwent EVAR using a bifurcated covered stent graft (main body: Gore Excluder, 28 × 14 × 180 mm; iliac limbs: Gore, 16 × 12 × 140 mm, 16 × 12 × 180 mm, and 16 × 14 × 100 mm), bilateral common iliac artery stent implantation, and embolization of the right internal iliac artery with coils (Cook, sizes 10 mm, 16 mm, and 4 mm). Intraoperative angiography demonstrated a proximal type Ia endoleak; despite balloon dilation at the graft junction, a small amount of proximal endoleak persisted, while both iliac arteries opacified well. Postoperative surveillance imaging was therefore planned and conducted at regular intervals.
Figure 2
On January 28, 2023, CTA demonstrated a circumferential low-attenuation rim around the stent graft, with a maximum diameter of approximately 91 mm (Figures 2C,D). The aneurysm sac appeared slightly larger than before surgery, but no obvious contrast filling was observed. The patient had no significant complaints, so continued close observation was recommended.
In October 2024, the patient developed low back pain without fever, chills, or other discomfort. CTA showed enlargement of the aneurysm sac to a diameter of 11 cm. Angiography suggested localized accumulation of contrast medium around the graft, suggestive of a possible type II endoleak (external hospital data unavailable for provision). On December 20, 2024, he underwent embolization of an internal iliac artery branch endoleak, after which his back pain was relieved. One week later, the patient again developed low back pain accompanied by fever (maximum temperature 38.2 °C) and was subsequently transferred to our hospital for further management.
After transmission, CTA showed postoperative changes following EVAR with covered stent graft and iliac artery balloon angioplasty, with multiple gas shadows within the original aneurysmal sac (Figure 2E), raising concern for an internal fistula with the small intestine. Laboratory tests showed elevated C-reactive protein (CRP; 184 mg/L), interleukin-6 (IL-6, 232 pg/mL), and erythrocyte sedimentation rate, with mild anemia (hemoglobin, 93 g/L), positive fecal occult blood testing, and an elevated D-dimer level. Blood cultures were negative for bacteria and fungi. Combining all the examinations, secondary AEF and graft infection were highly suspected. Surgical intervention was therefore undertaken. First, bilateral axillofemoral bypass using prosthetic grafts was performed. Upon completion, exploratory laparotomy revealed an ulcerative lesion of the ileum approximately 260 cm distal to the ligament of Treitz, adherent to the abdominal aortic lesion (Figure 2F). The AAA measured approximately 8 cm × 8 cm; the lumen was rigid, with no obvious pulsation observed. The aneurysm was then excised, and the endograft was removed (Figure 2G).
Postoperatively, the patient was transferred to the intensive care unit. He was extubated on postoperative day 1 and, with stable vital signs, was transferred to the general ward. Intraoperative cultures of infected tissue grew Lactobacillus paracasei. Based on susceptibility testing, vancomycin and linezolid were administered, and anticoagulation with warfarin was initiated. CTA of the entire aorta at discharge showed patent bypass grafts and no evidence of leakage from the residual stumps of the abdominal aorta and bilateral iliac arteries (Figure 2H). Concomitant pyogenic osteomyelitis was diagnosed; orthopedic consultation recommended continuation of antimicrobial therapy and lumbar immobilization with a brace. The patient was discharged in good condition 2 weeks after surgery. At the 12-month follow-up, the patient had a favorable outcome.
3 Discussion
AEF after EVAR is rare (incidence 0.26%–3.66%) but life-threatening. Although the duodenum is the most commonly involved site, fistulas affecting the jejunum (9), ileum, or colon (10) are exceedingly rare. To our knowledge, this is the first reported case of aortoileal fistula after EVAR, bringing the total number of cases with detailed patient-level data in the English literature to 43 (Table 1). These cases demonstrate marked male predominance (90.48%), with a mean age of 71.7 years and a median interval from EVAR to AEF of 18 months (range 1–180 months) (Table 2).
Table 1
| Date | Author | Age/Sex | Clinical presentation | Perioda (months) | Treatment for secondary AEF | Outcome | Estimated etiology |
|---|---|---|---|---|---|---|---|
| 2026 | Prent | 66/M | Back pain, fever | 27 | Endograft explant, extra-anatomic revascularization, bowel repair | Alive at 12 months | Endoleak |
| 2025 | Romanowska et al. | 68/M | Melena and fatigue | 92 | Abdominal drainage and antibiotic | Died | Endoleak |
| 2023 | Oka et al. | 86/M | Malaise and melena | 12 | Endograft explant, in situ reconstruction and bowel repair | Died after 4 weeks | IgG4-related periaortitis |
| 2022 | White et al. | 69/M | Back pain, melena, fever | 36 | Endograft explant, extra-anatomic revascularization, bowel repair | Alive at 3 months | Unknow |
| 2022 | Li et al. | 71/M | Hematemesis, melena, fever | 6 | Endograft explant, in situ reconstruction and bowel repair | Alive at 6 months | Unknow |
| 2021 | Moriyama et al. | 70/M | Fever | 24 | Endograft explant, in situ reconstruction and bowel repair | Alive at 35 months | Unknow |
| 2021 | Joshi et al. | 80/M | Fever, chills and melena | 2 | Only bowel repair | Alive at 9 months | Unknow |
| 2021 | Gunawardena et al. | 73/ | Melena, fever | 39 | Endograft explant, extra-anatomic revascularization, bowel repair | Died after 12 days | Type II endoleak. |
| 2021 | Hassan et al. | 65/M | Hemorrhage of digestive tract | 24 | Endograft explant, in situ reconstruction and bowel repair | Alive at 2 months | Unknow |
| 2020 | Nguyen et al. | 85/F | Abdominal pain | 25 | Endograft explant, extra-anatomic revascularization, bowel repair | Alive at 24 months | Unknow |
| 2020 | Hosaka et al. | 79/M | Fever and melena | 15 | Endograft explant, in situ reconstruction and bowel repair | Died after 25 months | Unknow |
| 2020 | Hosaka et al. | 71/M | Back pain | 58 | Endograft explant, in situ reconstruction and bowel repair | Alive at 69 months | Type II endoleak |
| 2020 | Hosaka et al. | 76/M | Anorexia and back pain | 74 | Endograft explant, in situ reconstruction and bowel repair | Alive at 53 months | Type II endoleak |
| 2020 | Hosaka et al. | 81/M | Chest pain and melena | 15 | Endograft explant, in situ reconstruction and bowel repair | Alive at 46 months | Type II endoleak |
| 2019 | Walter et al. | 75/M | Fever, abdominal pain | 48 | Endograft explant, in situ reconstruction and bowel repair | Alive at 5 months | Unknow |
| 2018 | Wang et al. | 87/M | Melena, fevers | 20 | Abdominal drainage and antibiotic | Alive at 23 months | Unknow |
| 2018 | Arworn et al. | 43/M | Hematemesis and melaena | 13 | Endograft explant, extra-anatomic revascularization, bowel repair | Alive at 9 months | Behcet's disease |
| 2018 | Jiang et al. | 85/M | Melena, tiredness, fever | 30 | Endograft explant, extra-anatomic revascularization, bowel repair | Alive at 15 months | Unknow |
| 2016 | Gülcü et al. | 72/M | Septic syndrome | 14 | Endograft explant, extra-anatomic revascularization, bowel repair | Unclear | Fungal infection |
| 2016 | Kadhim et al. | 66/M | Confusion, fever | 180 | Bowel repair | Alive at 12 months | Infection |
| 2014 | Zaki et al. | 75/M | Abdominal pain, hematemesis | 6 | Intraoperative death | Intraoperative death | Unknow |
| 2014 | Sörelius et al. | 58/M | Abdominal pain, fever | 30 | Endograft explant, extra-anatomic revascularization, bowel repair | Alive at 48 months | Stent graft had kinked |
| 2014 | Kasashima et al. | 79/M | Abdominal pain, melaena | 4 | None | Died | IgG4-related periaortitis |
| 2013 | Zhang et al. | 65/M | Fever | 38 | Endograft explant, extra-anatomic revascularization, bowel repair | Alive at 1 months | Unknow |
| 2012 | Veraldi et al. | 71/M | Melaena, lipothymia | 72 | Endograft explant, in situ reconstruction and bowel repair | Alive at 12 months | Unknow |
| 2012 | Kao et al. | 82/M | Bloody diarrhea | 3 | Endograft explant, extra-anatomic revascularization, bowel repair | Died after 2 days | Unknow |
| 2011 | McPhee et al. | 88/F | Nausea, dizziness | 48 | Endograft explant, extra-anatomic revascularization, bowel repair | Alive at 5 months | Type II endoleak |
| 2009 | Tromp et al. | 68/M | Symptom free | 1 | Endograft explant, in situ reconstruction and bowel repair | Alive at 6 months | Endoleak |
| 2009 | Lane et al. | 69/M | Fever, chills, lethargy, diarrhea | 6 | Endograft explant, extra-anatomic revascularization, bowel repair | Alive at 2 weeks | Unknow |
| 2009 | Chenu et al. | 67/M | Fever and lumbar pain | 14 | Endograft explant, in situ reconstruction and bowel repair | Alive at 2 months | Unknow |
| 2007 | Ruby et al. | 80/M | Abdominal pain, nausea | 58 | Endograft explant, in situ reconstruction and bowel repair | Alive at 13 months | Unknow |
| 2006 | Ghosh et al. | 52/M | Abdominal and back pain, hemat-emesis | 9 | None | Died after 1 days | Stent-graft infection |
| 2004 | French et al. | 69/F | Digestive hemorrhage | 16 | Endograft explant, extra-anatomic revascularization, bowel repair | Died at 6 days | Stent-graft infection |
| 2003 | AbouZamzam et al. | 67/M | Abdominal pain | 11 | Endograft explant, extra-anatomic revascularization, bowel repair | Alive at 4 months | Unknown endotension? |
| 2003 | Bertges et al. | 78/M | Infection, vomiting | 53 | Endograft explant, extra-anatomic revascularization, bowel repair | Alive at 1 month | Endoleak coil |
| 2003 | Elkouri et al. | 78/F | Hematemesis and melena | 17 | Endograft explant, extra-anatomic revascularization, bowel repair | Died at 12 h | Endoleak coil |
| 2003 | Alankar et al. | 76/M | Abdominal pain, hematochezia | 4 | Endograft explant, in situ reconstruction and bowel repair | Alive at 6 months | Type I endovascular leak |
| 2002 | Kar et al. | 78/M | Fever, malaise | 20 | Endograft explant, in situ reconstruction and bowel repair | Alive at 1 year | Unknown endotension? |
| 2001 | Parry et al. | 61/M | Digestive hemorrhage | 6 | Endograft explant, in situ reconstruction and bowel repair | Alive at 7 months | Peri-aortic inflammatory mass |
| 2000 | Makar et al. | 70/M | Abdominal pain, fever, digestive hemorrhage | 4 | Antibiotic only | Died | Crohn's disease |
| 2000 | Janne et al. | 62/M | Digestive hemorrhage, infection | 22 | Endograft explant, extra-anatomic revascularization, bowel repair | Alive at 40 months | Migrated and kinked stent graft |
| 1999 | Hausegger et al. | 53/M | Abdominal pain, digestive hemorrhage | 18 | Endograft explant, in situ reconstruction and bowel repair | Alive at 6 months | Migrated and kinked stent graft |
| 1998 | Norgren et al. | 71/M | Abdominal pain, digestive hemorrhage | 17 | Endograft explant, in situ reconstruction and bowel repair | Alive at 6 months | Peri-aortic inflammatory mass and ruptured graft |
Aorto-enteric fistulas after EVAR in English literature.
Period: Time after EVAR; F, female; M, male.
Table 2
| Characteristics | n (%) or mean ± SD (range) |
|---|---|
| Age (year) (n = 43) | |
|  Mean | 71.7 ± 9.62 (43–88) |
|  Sex (male/female), (male %) (n = 42) | 38/4 (90.48%) |
| Location of intestinal fistula (n = 43) | |
|  Duodenum | 40 (93.02%) |
|  Jejunum | 1 (2.33%) |
|  Ileum | 1 (2.33%) |
|  Colon | 1 (2.33%) |
|  Time after EVAR (months) | 28.63 ± 32.00 (1–180) |
| Vascular reconstruction (n = 36) | |
|  In situ reconstruction | 19 (52.78%) |
|  Extra-anatomic revascularization | 17 (47.22%) |
|  Overall mortality rate (n = 42) | 11/42 (26.19%) |
|  Mortality rate of surgical patients | 6/36 (16.67%) |
|  Mortality rate of nonsurgical patients | 4/5 (80.00%) |
|  Number of intraoperative deaths | 1 |
Summary of data from all 43 cases of AEF after EVAR in the English literature.
The pathogenesis of post-EVAR AEF is multifactorial. Established mechanisms include mechanical erosion by the stent graft, endograft migration or kinking (11), barbs/hooks injury (12), and persistent aneurysm sac pressurization due to endoleak or endotension (13). Type II endoleak is the most frequently reported cause of secondary enteric fistulization after EVAR (14). Additionally, coils left in situ after endoleak embolization may cause delayed bowel erosion (15). Other rare contributing factors include IgG4-related periaortitis and underlying inflammatory bowel disease (16). In the present case, a type II endoleak was identified and treated with coil embolization, followed by symptom onset only 7 days later. In contrast to the typically delayed presentations (months to years), this short interval raises the possibility that the embolization procedure itself may have accelerated fistula formation through local mechanical irritation, coil migration, or induction of inflammation. Rapid sac enlargement (from 9.1 cm to 11 cm) also occurred prior to fistula diagnosis. We hypothesize that coil embolization, particularly when followed by rapid sac enlargement, may convert a low-grade chronic inflammatory state into an acute fistulogenic process through localized ischemia, foreign body reaction, or micro-perforation, beyond simple mechanical erosion.
The ileal involvement is noteworthy, as the ileum is mobile and usually distant from the graft. Intraoperative adherence between the ileal lesion and aortic sac suggests that periaortic adhesions combined with chronic inflammation and sac expansion enabled fistula formation at this unexpected site.
Clinically, AEF presents with nonspecific symptoms. In this patient, recurrent low back pain and fever were prominent, associated with vertebral osteomyelitis. Key early warning signs include rapid sac enlargement, persistent back pain, perigraft gas/fluid on CT, and elevated inflammatory markers. These should prompt urgent evaluation for graft infection or AEF. Differential diagnoses include type II/III endoleak, endotension, graft infection, and post-interventional inflammation. Contrast-enhanced CT is the first-line imaging modality.
Management remains challenging. In the 43-case analysis, overall mortality was 26.19% (11/42) (17), with markedly higher rates in non-operatively managed patients (60% in-hospital) (18, 19). The 2016 AHA scientific statement recommends extra-anatomic revascularization for typical cases, while in situ reconstruction may be considered in selected low-risk patients (20). Among the 43 post-EVAR AEF cases, 36 underwent open surgery: 17 had extra-anatomic revascularization (e.g., axillofemoral bypass with graft excision and debridement), which eradicates infection but risks stump blowout, longer operative time, and greater trauma. The other 19 had in situ reconstruction, which is more anatomical, avoids stump rupture and additional incisions, and lowers amputation risk (21). Conduits include biologic or nonbiologic materials (22, 23), and omental flap coverage may facilitate infection control (24). No significant differences in mortality or infection-related complications have been shown between the two approaches (25), but in situ reconstruction should be avoided with extensive purulent peritoneal contamination. In emergencies (e.g., hemodynamic instability, massive hemorrhage, or poor surgical tolerance), endovascular therapy can serve as a temporizing measure (5), as one retrospective study found better perioperative survival with stent-grafts for life-threatening bleeding than with open surgery (5). In the present case, the patient underwent bilateral axillofemoral bypass, graft explantation, and primary ileal repair. For ileal fistulas, intestinal repair is generally straightforward compared with duodenal fistulas.
Culture-directed antibiotic therapy is mandatory. Intraoperative tissue yielded Lactobacillus paracasei; although often considered a commensal, its isolation in pure culture from periaortic tissue in the context of enteric fistula supports its role as a true enteric pathogen. We recommend at least 6–8 weeks of intravenous antibiotics followed by oral therapy, tailored to clinical response. Lifelong suppression may be required in cases of incomplete graft removal or highly virulent organisms (14).
This case provides several actionable insights for clinical practice. First, recent coil embolization for type II endoleak warrants close surveillance for accelerated AEF, particularly if new back pain or rapid sac enlargement develops. Second, sac enlargement and recurrent back pain are critical warning symptoms that should prompt early CTA or endoscopy. Third, AEF may involve mobile bowel segments such as the ileum when periaortic adhesions are present, emphasizing the need for thorough imaging and intraoperative inspection of all adherent bowel loops. Finally, timely extra-anatomic revascularization combined with graft removal can achieve favorable outcomes when fistula location allows simpler bowel repair.
4 Conclusion
Aortoileal fistula after EVAR for AAA is an extremely rare yet potentially fatal complication and should be recognized by both clinicians and patients. It may occur as early as 1 month post-operatively or even more than 10 years after EVAR; therefore, lifelong follow-up is needed. Once the diagnosis is established, in addition to antibiotic therapy, appropriate surgical management should be considered on an individual basis to achieve favorable outcomes.
5 Limitations
This study has several limitations. As a single case report, the findings may not be generalizable to broader patient populations. The precise mechanism of aortoileal fistula formation in this patient remains speculative due to the complex interplay of potential contributing factors, including type II endoleak, coil erosion, and possible inflammatory processes. Additionally, long-term outcomes beyond one year of follow-up are not available, limiting assessment of the durability of the surgical treatment.
6 Highlights
AEF following EVAR for AAA is a rare but severe complication.
Most reported AEF cases involved the duodenum.
Aortoileal fistula is exceptionally uncommon.
We report a case of aortoileal fistula with successful surgical management.
Lifelong follow-up is necessary to AEF patients.
Statements
Data availability statement
The raw data supporting this case report are available from the corresponding author upon reasonable request.
Ethics statement
The studies involving humans were approved by The Ethics Committee of the Second Affiliated Hospital, Zhejiang University School of Medicine. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.
Author contributions
YF: Writing – original draft, Writing – review & editing. YP: Project administration, Resources, Writing – original draft. HZ: Funding acquisition, Methodology, Writing – original draft. XM: Data curation, Software, Writing – original draft. JW: Supervision, Validation, Writing – review & editing. BC: Writing – review & editing, Conceptualization, Supervision, Writing – original draft.
Funding
The author(s) declared that financial support was received for this work and/or its publication. This work was supported by the Natural Science Foundation of Zhejiang Province, China, No. LQ21H020007.
Acknowledgments
We are thankful to the patients and all the physicians and technicians who participated in this case. We also appreciate the language editing service of Editgy.
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The author(s) declared that generative AI was not used in the creation of this manuscript.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fcvm.2026.1840464/full#supplementary-material
Abbreviations
AEF, Aortoenteric fistula; EVAR, endovascular aortic repair; AAA, abdominal aortic aneurysm; CTA, computed tomography angiography; AHA, American Heart Association.
References
1.
BergqvistDBjörckMNymanR. Secondary aortoenteric fistula after endovascular aortic interventions: a systematic literature review. J Vasc Interv Radiol. (2008) 19(2 Pt 1):163–5. 10.1016/j.jvir.2007.10.013
2.
HosakaANemotoMMotokiMAkaiAKatoM. Aortoduodenal Fistula after endovascular abdominal aortic aneurysm repair. Vasc Endovascular Surg. (2020) 54(5):445–8. 10.1177/1538574420918969
3.
MalekpourMIrvanJLHashmiAWidomKARyerEJ. Aortoenteric Fistula through a thrombosed graft. Am J Case Rep. (2020) 21:e922153. 10.12659/AJCR.922153
4.
OmranSRaudeBBurgerMKapahnkeSCarstensJCHaidarHet al. Aortoduodenal fistulas after endovascular abdominal aortic aneurysm repair and open aortic repair. J Vasc Surg. (2021) 74(3):711–719 e711. 10.1016/j.jvs.2021.02.027
5.
OikonomouKPfisterKKasprzakPMSchierlingWBetzTSachsamanisG. Treatment of secondary aortoenteric fistulas following AORTIC aneurysm repair in a tertiary reference center. J Clin Med. (2022) 11(15):4427. 10.3390/jcm11154427
6.
KahlbergARinaldiEPiffarettiGSpezialeFTrimarchiSBonardelliSet al. Results from the multicenter study on aortoenteric fistulization after stent grafting of the abdominal aorta (MAEFISTO). J Vasc Surg. (2016) 64(2):313–320 e311. 10.1016/j.jvs.2016.04.008
7.
MoulakakisKGSfyroerasGSMylonasSNMantasGPapapetrouAAntonopoulosCNet al. Outcome after preservation of infected abdominal aortic endografts. J Endovasc Ther. (2014) 21(3):448–55. 10.1583/13-4575MR.1
8.
SharifMALeeBLauLLEllisPKCollinsAJBlairPHet al. Prosthetic stent graft infection after endovascular abdominal aortic aneurysm repair. J Vasc Surg. (2007) 46(3):442–8. 10.1016/j.jvs.2007.05.027
9.
ArwornSOrrapinSChakrabandhuBReanpangTSettakornJLaohapensangK. Aorto-enteric Fistula after endovascular abdominal aortic aneurysm repair for Behcet's disease patient: a case report. EJVES Short Rep. (2018) 39:54–7. 10.1016/j.ejvssr.2018.05.004
10.
KadhimMMKRasmussenJBGEibergJP. Aorto-enteric Fistula 15 years after uncomplicated endovascular aortic repair with unforeseen onset of endocarditis. EJVES Short Rep. (2016) 31:16–8. 10.1016/j.ejvssr.2016.03.004
11.
SöreliusKSundbomMManiKWanhainenA. Hybrid treatment of a post-EVAR aortoenteric fistula. Vascular. (2014) 22(5):385–9. 10.1177/1708538113501661
12.
ChenuCMarcheixBBarceloCRousseauH. Aorto-enteric fistula after endovascular abdominal aortic aneurysm repair: case report and review. Eur J Vasc Endovasc Surg. (2009) 37(4):401–6. 10.1016/j.ejvs.2008.11.037
13.
RomanowskaMAKuseMYelETOstrowskiTGasiorowskiOGalazkaZ. Aorto-Duodenal Fistula after emergency endovascular repair of a 14-cm abdominal aortic aneurysm in a 68-year-old man. Am J Case Rep. (2025) 26:e948062. 10.12659/AJCR.948062
14.
GunawardenaTSaseekaranBAbeywickramaSCassimRWijeyaratneM. Aortoenteric Fistula after endovascular aneurysm repair. Case Rep Vasc Med. (2021) 2021:8828838. 10.1155/2021/8828838
15.
BertgesDJVillellaERMakarounMS. Aortoenteric fistula due to endoleak coil embolization after endovascular AAA repair. J Endovasc Ther. (2003) 10(1):130–5. 10.1177/152660280301000125
16.
OkaHSumitomoSShimizuHKanamoriMYamashitaDNishiokaHet al. A case of aortoduodenal fistula caused by IgG4-related periaortitis. Mod Rheumatol Case Rep. (2023) 7(1):188–91. 10.1093/mrcr/rxac051
17.
ZakiMTawfickWAlawyMElKassabyMHynesNSultanS. Secondary aortoduodenal fistula following endovascular repair of inflammatory abdominal aortic aneurysm due to Streptococcus anginosus infection: a case report and literature review. Int J Surg Case Rep. (2014) 5(10):710–3. 10.1016/j.ijscr.2013.10.016
18.
WangSKFajardoAMotaganahalliRLGuptaAK. Successful treatment of an infected zenith fenestrated endograft without explantation. Vasc Endovascular Surg. (2018) 52(7):569–72. 10.1177/1538574418774663
19.
MakarRReidJPherwaniADJohnstonLCHannonRJLeeBet al. Aorto-enteric fistula following endovascular repair of abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. (2000) 20(6):588–90. 10.1053/ejvs.2000.1247
20.
WilsonWRBowerTCCreagerMAAmin-HanjaniSO'GaraPTLockhartPBet al. Vascular graft infections, mycotic aneurysms, and endovascular infections: a scientific statement from the American Heart Association. Circulation. (2016) 134(20):e412–60. 10.1161/CIR.0000000000000457
21.
LiWDWuGYSongBZhaoJLiXQZhouM. Case report: remedial surgical treatment of aorto-duodenal fistula with infected aneurysm after endovascular aortic repair. Front Cardiovasc Med. (2022) 9:975871. 10.3389/fcvm.2022.975871
22.
MuftyHMichielsTVan WijngaerdenEFourneauI.In situ reconstruction with autologous veins for the treatment of infected abdominal endografts: single center experience. Surg Infect (Larchmt). (2022) 23(2):150–4. 10.1089/sur.2021.301
23.
WalterCTaherFRiegerHAssadianAFalkensammerJ. Endograft infection due to secondary aortoenteric Fistula treated with custom-made Bovine in situ aortic bifurcation graft. Vasc Endovascular Surg. (2019) 53(2):165–9. 10.1177/1538574418805868
24.
ParryDJWaterworthAKesselDRobertsonIBerridgeDCScottDJ. Endovascular repair of an inflammatory abdominal aortic aneurysm complicated by aortoduodenal fistulation with an unusual presentation. J Vasc Surg. (2001) 33(4):874–9. 10.1067/mva.2001.112328
25.
NordanstigJBehrendtCABaumgartnerIBelchJBackMFitridgeRet al. Editor’s choice—european society for vascular surgery (ESVS) 2024 clinical practice guidelines on the management of asymptomatic lower limb peripheral arterial disease and intermittent claudication. Eur J Vasc Endovasc Surg. (2024) 67(1):9–96. 10.1016/j.ejvs.2023.08.067
Summary
Keywords
abdominal aortic aneurysm, aortoenteric fistula, aortoileal fistula, case report, endovascular abdominal aortic aneurysm repair
Citation
Feng Y, Pan Y, Zhou H, Meng X, Wang J and Chen B (2026) Aortoileal fistula following endovascular repair of an abdominal aortic aneurysm: a case report. Front. Cardiovasc. Med. 13:1840464. doi: 10.3389/fcvm.2026.1840464
Received
27 March 2026
Revised
22 June 2026
Accepted
26 June 2026
Published
22 July 2026
Volume
13 - 2026
Edited by
Ayman Elbadawi, University of Texas Medical Branch at Galveston, United States
Reviewed by
Halil Ibrahim Altunbulak, Bitlis Tatvan State Hospital, Türkiye
Daijirou Akamatsu, Osaki Citizen Hospital, Japan
Mohamed Hamed, Florida Atlantic University, United States
Updates
Copyright
© 2026 Feng, Pan, Zhou, Meng, Wang and Chen.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Bing Chen 2114008@zju.edu.cn
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.