Open or Endovascular Repair of Secondary Aortoenteric Fistulae?

Abstract

Secondary aortoenteric fistula (AEF) complicate 0.3e2.5% of all open aortic surgical procedures, with the incidence being lower following endovascular aortic aneurysm repair. It is, however, one of the most dangerous complications for a patient to encounter, with the highest mortality rates being observed in patients presenting with massive haemorrhage. In the past, patients with secondary AEF have usually been treated with total graft excision and either oversewing of the aortic stump and extra anatomic revascularisation or in-situ replacement with a rifampicin bonded prosthesis or (less commonly) deep venous conduits. Because of the considerable morbidity and mortality associated with these difficult and prolonged redo open procedures; the emergence of an endovascular solution has been actively welcomed. There are considerable theoretical attractions associated with the endovascular treatment of secondary AEF, most notably; reduced physiological stresses to the patient, shorter operating times, less trauma and reduced transfusion requirements, all of which translate into lower mortality and morbidity. However, following the publication of several small case series from around the world, there are now concerns that while the endovascular treatment of AEF may confer better short term outcomes, this may come with a heavy price in the long term. In effect; the endovascular treatment of secondary AEF may