Surgery for secondary aorto-enteric fistula or erosion (SAEFE) complicating aortic graft replacement: a retrospective analysis of 32 patients with particular focus on digestive management.

Abstract

Optimal management of patients with abdominal secondary aorto-enteric fistula or erosion (SAEFE) complicating aortic graft replacement is controversial. The aim of the present study was to report on the postoperative and long-term outcomes of patients operated on for SAEFE. From 2002 to 2012, consecutive patients operated on for SAEFE were identified. All were managed with in situ revascularization by cryopreserved allograft associated with the treatment of the digestive tract involved. Postoperative and long-term outcomes were collected prospectively and analysed retrospectively. A total of 32 patients (median age 65 years) underwent an aortic replacement for SAEFE after a median of 5 years after the initial aortic surgery. Fistula location was duodenal (n = 20), small bowel (n = 6), colonic (n = 5), or gastric (n = 1). Digestive treatment included suture (n = 16), resection with anastomosis (n = 13), and Hartmann's procedure (n = 3). An omentoplasty was performed in 18 patients (56 %), and 17 patients (53 %) had a feeding jejunostomy. Postoperative mortality was 25 %. Among perioperative risk factors, preoperative shock was associated with postoperative mortality (p = 0.009). Among the 24 patients who survived, 15 patients developed 27 postoperative complications (overall morbidity rate of 62.5 %), including six (25 %) patients with severe morbidity (Dindo III-IV). Reoperation was required in five (21 %) patients. During follow-up (median 31 months), no patient developed a recurrent aorto-enteric fistula. Surgery for SAEFE is a major undertaking, with high mortality and morbidity. Excision of the prosthetic graft with cryopreserved allograft replacement and management in a tertiary referral centre with expertise in both vascular and digestive surgery allows good long-term results.