Dual complications of type I endoleak and aorto-enteric fistula post-EVAR: A case report and review of literature

Aortoenteric fistula (AEF) is a rare but life-threatening complication following endovascular aortic repair (EVAR). Although individual complications such as endoleak and graft infection are well described, the simultaneous occurrence of an endoleak and AEF is exceedingly uncommon and poses significant diagnostic and therapeutic challenges. Most reported cases of this dual complication involve type II endoleaks; to our knowledge, this represents the first reported case of a type I endoleak occurring in conjunction with an AEF, specifically an aortocolic fistula. We describe a 94-year-old woman who presented with abdominal pain and sepsis 1 year after undergoing EVAR for a ruptured infrarenal abdominal aortic aneurysm. Contrast-enhanced computed tomography (CT) demonstrated a type I endoleak with associated graft infection and imaging findings highly suggestive of an aortoenteric fistula. This case adds to the limited existing literature and underscores the importance of maintaining a high index of suspicion for this potentially fatal dual complication, while highlighting the critical role of cross-sectional imaging in timely diagnosis and in guiding appropriate clinical management.