Long Term Results of In Situ Reconstruction with Cryopreserved Arterial Allografts for Secondary Aorto Enteric Fistulas

Abstract

Introduction - Secondary aorto enteric fistula (SAEF) is a rare complication (0.3% to 1.6%) with a high morbidity rate. The infection rate of aortic vascular graft is described between 0.6% and 3%. SAEF represents 20 to 45% of these vascular graft infections. The treatment can be performed by different methods and in various steps. The choice of the treatment remains controversial. The objective of our study was to evaluate the long term results of the treatment of secondary aorto enteric fistulas by in situ reconstruction with cryopreserved arterial allograft. Methods - Between 1995 and 2015, 30 patients (mean age: 75 years, 27 males, 3 females) were surgically treated for SAEF in 3 French university hospitals. 16 patients were initially treated for infrarenal abdominal aortic aneurysm and 14 for occlusive aortic disease. Mean time before occurrence of SAEF was 72 months. Surgical treatment consisted of total graft excision and in situ reconstruction with cryopreserved arterial allografts as well as digestive tract reconstruction. Data were collected retrospectively. Primary endpoint was overall survival at 12 and 36 months. Secondary endpoints were primary patency, reinfection rate, postoperative morbidity and limb salvage rate. Results - Survival rate at 12 and 36 months were respectively 70% and 65%. Mean follow up was 39 months (range: 1-194). The 30-day postoperative mortality rate was 23%. Primary patency rate at 1 year and 5 years were 95% and 86%, respectively. There were 2 allograft thromboses. Limb salvage rate was 100%. There was no recurrence of aorto enteric fistula. Reinfection occurred in 2 patients (7%). The most frequent organisms identified were Candida albicans (36%) and Escherichia coli (32%). There were no bacterial findings for 5 patients (17%). The fistula was found between the graft anastomosis and the duodenum in 87% of the patients. Digestive tract treatment was performed with duodenal resection for 13 patients (47%), duodenal suture for 12 (40%), intestinal resection for 5 (17%) and 6 stoma creations. Conclusion - The long term results of SAEF treated by in situ reconstruction with cryopreserved arterial allografts were satisfactory. The occurrence of SAEF threatens the vital prognosis of the patient and long term surveillance is mandatory.