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Successful bridge therapy with initial endovascular repair for arterioenteric fistula resulting from pseudoaneurysm rupture with massive gastrointestinal hemorrhage after pancreas transplantation.

Pseudoaneurysm after pancreas transplantation has a reported incidence of 1.4% to 8.0% and may be caused by perioperative infection. Subsequent pseudoaneurysm rupture is a rare cause of arterioenteric fistula. Only 28 cases of arterioenteric fistula after pancreas transplantation have been reported in the past 20 years. We experienced a rare case of arterioenteric fistula resulting from pseudoaneurysm rupture after pancreas transplantation. We successfully treated the arterioenteric fistula with multi-staged bridge therapy composed of initial endovascular aneurysm repair, secondary isolation of the fistula, and definitive open repair with extra-anatomic bypass. No complications occurred in 1 year of follow-up; this staged therapy seems feasible for patients with arterioenteric fistula.

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