From the Guidelines
Iliac artery stent to bowel fistula is a life-threatening complication that requires immediate surgical intervention, with a focus on removing the infected stent, repairing the arterial damage, and treating the bowel involvement. This condition is characterized by an abnormal connection between the iliac artery, where a stent has been placed, and the intestine, leading to severe complications such as gastrointestinal bleeding, abdominal pain, and signs of infection or sepsis 1. The management of this condition involves a multidisciplinary approach, including emergency vascular and general surgery consultation, administration of broad-spectrum antibiotics, fluid resuscitation, and blood product support as needed.
Key considerations in the management of iliac artery stent to bowel fistula include:
- Immediate surgical intervention to remove the infected stent and repair the damaged artery and bowel
- Use of broad-spectrum antibiotics, such as piperacillin-tazobactam and vancomycin, to treat infection and prevent further complications
- Fluid resuscitation and blood product support to stabilize the patient
- Temporary endovascular measures may be used as a bridge to surgery in unstable patients
- Long-term antibiotic therapy, typically 4-6 weeks, is necessary following surgical repair to prevent recurrent infection or bleeding.
The development of an iliac artery stent to bowel fistula is often due to chronic inflammation, infection, or erosion of the stent through the arterial wall into adjacent bowel loops, as noted in the context of endovascular infections 1. Given the high mortality rate associated with this complication, prompt and aggressive treatment is essential to improve outcomes and reduce the risk of fatal hemorrhage or other complications. Surgical repair with removal of the infected stent and reconstruction of the affected area is the definitive treatment, with the goal of preventing further complications and improving the patient's quality of life.
From the Research
Iliac Artery Stent to Bowel Fistula
- An iliac artery stent to bowel fistula is a rare but potentially life-threatening condition that requires urgent treatment 2, 3, 4.
- The condition can present with symptoms such as fever, gastrointestinal hemorrhage, and hematuria 2, 3, 5.
- Endovascular treatment with a covered stent graft can be used as a bridge to definitive open surgery 3.
- However, postoperative graft infection remains a major concern, and graft removal and in situ reconstruction may be necessary 2.
- The use of endovascular stent-graft repair can also lead to the development of rare ilio-enteric fistulas 4.
- Prompt diagnosis and treatment are crucial to prevent high rates of morbidity and mortality associated with uretero-arterial fistulas 5.
Treatment Options
- Endovascular stent graft repair can be used to treat ilio-iliac arteriovenous fistula (AVF) associated with aneurysms affecting the abdominal aortic and iliac arteries 6.
- Graft removal and in situ reconstruction with femoral vein grafts can be used to treat late stent graft infection after emergency endovascular repair of a secondary iliac artery-enteric fistula 2.
- Extra-anatomic arterial bypass, bowel resection, and ureter ligation can be used to treat iliac artery-uretero-colonic fistula 3.
- Embolization of the internal iliac artery can be used to treat uretero-internal iliac artery fistula 5.