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Due to a complex revascularization history including prior aortobifemoral and femoral-femoral bypasses and recurrent thromboses, she underwent staged management: endovascular exclusion followed three days later by definitive open aortic repair and left leg revascularization. Perioperative infectious workup guided treatment, and recovery was uneventful with discharge on hospital day 10.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/staged-endovascular-and-open-surgical-repair-of-anaortoenteric-fistula-with-complex-autologous-lower-extremity-revascularization/432917/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/staged-endovascular-and-open-surgical-repair-of-anaortoenteric-fistula-with-complex-autologous-lower-extremity-revascularization/432917.png","ImageObject",300,407,{"name":92,"@type":93},"Blue Pony","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What diagnosis prompted surgical and endovascular treatment in this case?","Question",{"text":112,"@type":113},"Computed tomography angiography identified an infrarenal aortoenteric fistula, associated with an occluded prior aortobifemoral bypass limb and a left groin rim-enhancing abscess.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the aortoenteric fistula managed during the staged approach?",{"text":117,"@type":113},"The team first performed staged endovascular exclusion of the aortoenteric fistula to temporize the situation, then proceeded three days later to definitive open aortic repair.",{"name":119,"@type":110,"acceptedAnswer":120},"What elements of revascularization were performed to address limb ischemia?",{"text":121,"@type":113},"Definitive open surgery included explantation of prior bypass components, bowel resection with repair and omental coverage, and femorofemoral and iliofemoral procedures to restore inline flow, supported by targeted arterial repairs and patch angioplasty.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},432917,1790716539,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962090760266,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Staged endovascular and open surgical repair of anaortoenteric fistula with complex autologous lower extremity revascularization  \nMark S. Zemela, MD,a Benjamin Feng, MD,a Abigail Clark, MD,a Katherine McMackin, MD,a and Joseph V. Lombardi, MD, MBA,b Camden and Atlantic City, NJ  \nABSTRACT  \nA 72-year-old female presented to an outside hospital after her legs gave out and she fell at home. Computed tomography angiography revealed an aortoenteric fistula. Given her extensive and complex revascularization history, including an aortobifemoral bypass, femoral-femoral bypass, and multiple lower extremity revascularizations, she was transferred to our facility for further management and definitive repair. She underwent staged endovascular exclusion of the aortoenteric fistula followed by definitive open aortic repair and lower extremity revascularization 3 days later. Her postoperative course was uneventful, and she was discharged on hospital day 10. (J Vasc Surg Cases Innov Tech 2026;12:102067.)  \nKeywords: Aortoenteric fistula; Chronic limb threatening ischemia; Infected bypass; Revascularization  \nWith consent for publication obtained from the patient per our institution’s policies, a 72-year-old female, with past medical history of deep venous thrombosis of bilateral lower extremities on Eliquis, hypertension, hyperlipidemia, coronary artery disease, and extensive peripheral artery disease, presented to an outside hospital for a fall preceded by her legs buckling and giving out. Her vascular surgical history includes a femoral-femoral bypass in 2021 for left lower extremity acute limb ischemia secondary to occluded left common iliac artery. This bypass subsequently thrombosed when she had a pause in her anticoagulation to undergo endoscopy, requiring an end-to-side aortobifemoral (ABF) bypass as she also acutely developed right common iliacartery occlusion. Less than 1 month later, due to outflow issues with chronically diseased left superficial femoral artery, she underwent jump bypasses using cryovein from the left limb of the ABF bypass to the left profundafemoris artery and anterior tibial artery, both of which were found to be acutely occluded requiring percutaneous throm bectomy in 2022 (Fig 1) . All the patient’s prior surgical history was performed at an outside hospital, and after the 2022 interventions, there was no other  \nFrom the Division of Vascular Surgery, Cooper University Hospital, Camdena; and the Heart and Vascular Institute, Atlanticare Medical Center, Atlantic City. b  \nPresented at the International Aortic Summit, Noord, Aruba, October 16-18, 2024.  \nCorrespondence: Mark S. Zemela, MD, Department of Vascular Surgery, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 (e-mail: [zemela-mark@cooperhealth.edu](zemela-mark@cooperhealth.edu)) .  \nThe editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.  \n2468-4287  \n© 2025 The Author(s) . Published by Elsevier Inc. on behalf of Society for Vascular Surgery. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)) .  \n[https://doi.org/10.1016/j.jvscit.2025.102067](https://doi.org/10.1016/j.jvscit.2025.102067)  \ndocumentation of surgical intervention prior to her acute presentation to our institution 2 years later.  \nAt the outside hospital, she was found to have a hemoglobin of 3.7 g/dL, and computed tomography angiography (CTA) demonstrated an occluded left limb of her prior ABF bypass with an infrarenal aortoenteric fistulaand left groin rim-enhancing abscess for which she was transferred to our institution for escalation of care and definitive management (Fig 2) . CTA also demonstrated extensive peripheral arterial disease of the bilateral lower extremities, including multifoca","cbCaihRPWAcwJUTO","https://ap.wps.com/l/cbCaihRPWAcwJUTO","pdf",3288877,"English","# Abstract\n# Case report\n## Index staged procedures\n## Definitive repair and revascularization","[{\"question\":\"What diagnosis prompted surgical and endovascular treatment in this case?\",\"answer\":\"Computed tomography angiography identified an infrarenal aortoenteric fistula, associated with an occluded prior aortobifemoral bypass limb and a left groin rim-enhancing abscess.\"},{\"question\":\"How was the aortoenteric fistula managed during the staged approach?\",\"answer\":\"The team first performed staged endovascular exclusion of the aortoenteric fistula to temporize the situation, then proceeded three days later to definitive open aortic repair.\"},{\"question\":\"What elements of revascularization were performed to address limb ischemia?\",\"answer\":\"Definitive open surgery included explantation of prior bypass components, bowel resection with repair and omental coverage, and femorofemoral and iliofemoral procedures to restore inline flow, supported by targeted arterial repairs and patch angioplasty.\"}]","Staged endovascular and open surgical repair of anaortoenteric fistula with complex autologous lower extremity revascularization | PDF",1790661911,13]