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(a) Left common iliac artery anastomotic pseudoaneurysm and (b) pseudoaneurysms (PSA) of the left common iliac (bold arrow) and at the level of the proximal anastomosis (dashed arrow) where the AEF was covered by a stent graft. Note the loss of the fat plane between the duodenum and the aorta.
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Computed tomography (CT) scan revealed evidence of an AEF with loss of fat planes, soft tissue thickening, and a pseudoaneurysm between the aorta and duodenum, and another pseudoaneurysm distally at the left common iliac artery (LCIA) anastomosis (see Figure 1(a) and (b)).
(a) Left flank retroperitoneal incision inferior to the 10th rib with retractors in place and wide exposure of the aorta. (b) Illustration depicting the AEF, proximal control (supra-renal), and distal control (left CIA and right CFA). (c) Excluded and bypassed old graft. Proximal anastomosis to infra-renal aorta and distally to Rt CFA and Lt CIA. (d) Retroperitoneal view after opening the peritoneum and excising the old graft and fistulous bowel.
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This was performed through a left retroperitoneal incision (see Figure 2(a)). Supra-renal clamping was necessary to perform the proximal anastomosis (see Figure 2(b)). Distal anastomoses were to the LCIA and right common femoral artery via a right groin exposure (see Figure 2(c)). This was done by opening the peritoneum cranio-caudally and stapling either side of the fistulous bowel to avoid contamination (see Figures 2(d) and 3).