Aortoileal fistula following endovascular repair of an abdominal aortic aneurysm: a case report.

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.