Diagnosis and staged endovascular management of secondary aortic graft-enteric fistula

Secondary Aortic graft-enteric fistula (GEF) is a rare but life-threatening complication following aortic reconstructive surgery. Early diagnosis is challenging, and urgent intervention is mandatory. This is the case report of a 67-year-old male with prior aorto-popliteal bypass surgery presented with recurrent melena and severe anemia. Computed tomography angiography demonstrated contrast extravasation from the distal aortic graft stump into an adjacent proximal small-bowel loop, with perigraft air suggestive of secondary GEF. Positron emission tomography–computed tomography findings supported underlying graft infection. As the distal graft was chronically occluded and non-functional, endovascular embolization of the graft stump was performed to control hemorrhage. Initial coil embolization achieved temporary hemostasis; however, rebleeding occurred 15 days later due to coil migration and persistent stump perfusion. Repeat embolization was done using additional coils, glue, and deployment of an Amplatzer vascular plug which achieved complete exclusion. At 5-month follow-up, the patient remained clinically stable without recurrent bleeding. Staged endovascular therapy can provide life-saving hemorrhage control in high-risk patients with secondary GEF involving a non-functional graft. However, recurrence due to device migration and persistent infection remains a limitation, requiring meticulous technique and close follow-up.