Graft-Enteric Fistulas and Erosions, Complications of Synthetic Aortic Grafting

Abstract

Operative results of 12 patients with graft-enteric fistula (GEF) and two patients with graft-enteric erosion (GEE) operated on at our department be tween 1974 and 1984 were analyzed. Preoperative gastrointestinal bleeding was noted in all patients and pre sented as melena in 11 (79%), hematemesis in 10 (71 %), and hematochezia in 7 (50%). Eleven of 14 patients had signs of infection with fever, leukocytosis and hy persedimentation. Preoperative aortography or barium contrast studies were performed in 10 patients, but none of these investigations were diagnostic. Extirpation of prosthesis and closure of the bowel was performed in 10 pa tients. Operative mortality was 64,3%. It is concluded that GEF or GEE must be suspected in all patients presenting with gastrointestinal bleeding after reconstructive aortic surgery. Immediate laparotomy with extensive and careful exploration of the graft region is the best and safest diagnostic procedure. Fibre-optic endoscopy of the upper gastroin testinal tract performed on the operating table is a reasonable investigation to rule out other causes of bleeding. Total graft excision with axillofemoral recon struction gives the best survival rates.