Secondary aorto-enteric fistula - still a devastating complication of major vascular surgery

Abstract

Despite advances in vascular surgery and intensive care, secondary aorto-enteric fistulas (AEF) remain a serious threat of major vascular interventions. This report summarizes our experience in the treatment of this condition. Nineteen patients with secondary AEF admitted between Jan 2004 and Dec 2008 were prospectively enrolled into this cohort observational study. Nine of them presented with massive gastrointestinal bleeding and hemorrhagic shock. None of the patients died preoperatively. Graft in situ replacement was performed in eight patients (42 %), extraanatomic repair in five (26 %), proximal anastomotic reconstruction in five (26 %) and aortic stump closure in one (5 %). One patient died during the operation. Twelve other patients died during hospitalization (days 1 - 100 postop). Complications occurred in 83 % of patients surviving the operation. During follow-up two further patients died suddenly, both probably due to recurrence of fistula. Overall mortality was 79 %. Four remaining patients are alive and without signs of graft infection at a mean follow-up of 45 months (34 - 57). AEF treatment still carries a significant mortality and morbidity. It seems that extraanatomic reconstruction is the best possible therapeutic modality provided the patient's condition allows for a prolonged operation. We advise cautious use of the silver-coated polyester prostheses for "in situ" reconstructions in cases with AEF.