In situ reconstruction with autologous graft in the treatment of secondary aortoenteric fistulas: A retrospective case series.

Claudio F Feo,Alessando Fancellu,Giorgio C Ginesu,Alberto Porcu,Antonio Pinna,Panagiotis Paliogiannis,Francesca Galotti

doi:10.1016/j.amsu.2019.11.020

Claudio F Feo, Alessando Fancellu + Show 5 more

Open Access

https://doi.org/10.1016/j.amsu.2019.11.020

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Abstract

Infections caused by secondary aortoenteric fistulas (SAEF) may be extremely complex and threaten patient's life. We report our surgical approach to SAEF consisting in removal of the infected graft and in situ reconstruction using an autologous venous graft.Seven consecutive patients with SAEF treated with graft removal and in situ reconstruction using an autologous venous graft from 2008 to 2017 were reviewed. Six of seven patients (86%) survived 30-day. In one case a graft thrombosis and acute lower limb ischemia occurred requiring re-operations. All patients received injective antibiotic therapy for 20 days, followed by oral therapy for 3 months. There were no major complications at long-term follow-up.Our results suggest that superficial femoral vein reconstruction of the abdominal aorta for SAEF is effective with an acceptable in-hospital mortality and low rate of major complications. We stress the importance of the deep femoral veins to create the graft because the large saphenous vein is often affected by significant intimal hyperplasia that can cause steno-occlusive complications.

Highlights

Our results suggest that superficial femoral vein reconstruction of the abdominal aorta for Secondary aortoenteric fistulas (SAEF) is effective with an acceptable in-hospital mortality and low rate of major complications
Primary aortoenteric fistulas (PAEF) are very rare entities that are usually caused by erosion of an aortic aneurysm into the duodenum [1,2]
As the treatment of choice for SAEF is still under debate, we describe our surgical approach to SAEF consisting in removal of the infected graft and in situ reconstruction using a novel autologous venous graft

Summary

Introduction

Primary aortoenteric fistulas (PAEF) are very rare entities that are usually caused by erosion of an aortic aneurysm into the duodenum [1,2]. Secondary aortoenteric fistulas (SAEF) are complications of aortic grafting surgery and they are relatively more frequent. Infection of prosthetic vascular grafts is a difficult challenge for vascular surgeons. Infections caused by SAEF may be extremely complex and threaten patient's life. Aortic graft excision and staged or simultaneous extra-anatomic bypass is the historical gold standard of SAEF repair, this procedure is associated with a very high morbidity. Several different in situ reconstruction techniques have been developed over the years, but presently no definite conclusion can be drawn

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