We previously described the case of a 47-year-old man who experienced perioperative graft occlusion after infrarenal aortic
endarterectomy and aortobifemoral expanded
polytetrafluoroethylene bypass graft for occlusive disease. The patient was treated with local graft thrombolysis and stenting of an intimal flap at the level of the endarterectomized aorta next to the aortic anastomosis. An urgent
laparotomy performed 6 years later showed aortic wall perforation by the
stent with a large aortoenteric
fistula. Surgical treatment included removal of the
stent and the aortobifemoral graft, bowel repair, and extra-anatomic lower-limb revascularization by axillofemoral and cross-femoral bypass grafting. The patient was discharged 12 days later with no early complications. Although local thrombolysis and stenting may be a technically feasible technique instead of reoperation in early aortofemoral graft
thrombosis, long-term results of this procedure may be affected by perigraft
hematoma due to perioperative thrombolysis, increased risk of
infection due to the prolonged intragraft cannulation, and risk of
stent-related aortic injury, especially if an
endarterectomy has been performed. All these issues may increase the risk of late aortoenteric
fistula. More experience with hybrid, open/
endovascular procedures, and more contemporary
stent-based devices is needed to assess the efficacy and safety of this alternative treatment.