Introduction <p>Secondary aortoenteric fistula (SAEF) is a rare complication following artificial vascular replacement. We present a patient who underwent successful surgical treatment for SAEF &gt; 40 years after the initial surgery.</p> Case presentation <p>A 66-year-old woman underwent right subclavian artery–abdominal aorta bypass surgery for abdominal aortic stenosis due to Takayasu disease 43 years earlier. Endoscopy revealed exposure of the artificial vascular graft in the descending duodenum. Bilateral axillary artery–femoral artery artificial vascular bypass surgery was performed prior to removing the original artificial vessels. However, hypotension developed intraoperatively. Therefore, the artificial vascular graft was partially resected, and another bypass surgery was performed with a new artificial vessel between the original artificial vessels and the femoral artery. The duodenum was then resected as a partial wedge, with side-to-side anastomosis with the jejunum.</p> Conclusion <p>In this case, SAEF was diagnosed by endoscopy and treated with successful revascularization and minimal intestinal reconstruction.</p>