Late outcome following open surgical management of secondary aortoenteric fistula

Abstract

We reviewed the perioperative and long-term outcomes after the surgical management of secondary aortoenteric fistulas. Over a 20-year period (1989-2009), 48 patients (33 men and 15 women; mean age, 64years) were treated for secondary aortoenteric fistulas (SAEF). Most of the patients presented with symptoms of gastrointestinal bleeding (42 cases), or of serious septicaemia and general septic conditions (19 cases). Twenty-eight patients (58.3%) required an emergency procedure and were admitted with an unstable hemodynamic status. Repairs were accomplished by graft removal and an axillobifemoral bypass (n = 11), in situ reconstruction with a silver-impregnated prosthetic replacement (n = 21), a Dacron graft replacement (n = 7), a cryopreserved homograft replacement (n = 8) or an in situ deep vein replacement (n = 2). Early perioperative (<30day) mortality was 45.8%. There was a significant difference in the mortality rates between patients who had an emergency procedure (59.2%) and patients who underwent urgent (38.0%) operations (p < 0.04). The average follow-up period was 48.6 ± 16months. There were eight late deaths; three of which were related to the SAEF treatment. The cumulative mortality rate was 34% at 3years. The in situ silver graft replacement group cumulative survival rate was 72% at 3years. No significant difference was observed in mortality on the complete or partial graft removal. Six late graft failures occurred; four of them resulted in amputation and three of them were associated with a recurrent infection. Freedom from amputation was 76.5% at both 3 and 5years. Late infections occurred in six patients. Freedom from recurrent infection was 80.8% and 81.4% at 3years in the whole study group and in the in situ silver graft group, respectively. The infect free rate at 3years was the same compared the complete or partial graft removal The long-term outcomes associated with aortoenteric fistula repair might be favourable when silver-impregnated grafts were used as an in situ strategy. The eradication of infection is possible in mid-term follow-up with partial graft replacement, which associated with a lesser operative load.