BACKGROUND: Secondary aortoenteric fistula is a rare but severe complication occurring after abdominal aortic graft implementation. OBJECTIVES: The aim of our study was to review the clinical presentation, diagnosis and postoperative course of patients with aortoenteric fistulas following vascular operations on the abdominal aorta in the years 2000-2014. MATERIAL AND METHODS: Among all the patients treated in our center, during a 10-year period, aortoenteric fistulas were observed in 24 cases. The first symptoms occurred between 4 weeks and 8 years after the procedure (3.4 years on average). The most common clinical presentation was gastrointestinal bleeding in 16 cases (66.7%). All patients underwent surgical repair of an aortoenteric fistula, with graft removal and replacement in situ using silver impregnated prosthesis. RESULTS: The 30-day mortality rate after surgical treatment of SAEF was 37.5% (9 patients). Causes of death included: hemorrhagic shock, multi-organ failure and myocardial infarction. The early complications after the surgical repair of an aortoenteric fistula occurred in 19 (79.2%) patients. Mortality during the one-year follow-up period was 38.5% (5 patients) and the one-year complication rate was 69.2%. CONCLUSIONS: Each patient with a history of abdominal aortic graft implementation and presenting symptoms of gastrointestinal bleeding requires careful diagnosing for aortoenteric fistula. New methods of surgical treatment offering lower mortality should be developed.
BACKGROUND: Secondary aortoenteric fistula is a rare but severe complication occurring after abdominal aortic graft implementation. OBJECTIVES: The aim of our study was to review the clinical presentation, diagnosis and postoperative course of patients with aortoenteric fistulas following vascular operations on the abdominal aorta in the years 2000-2014. MATERIAL AND METHODS: Among all the patients treated in our center, during a 10-year period, aortoenteric fistulas were observed in 24 cases. The first symptoms occurred between 4 weeks and 8 years after the procedure (3.4 years on average). The most common clinical presentation was gastrointestinal bleeding in 16 cases (66.7%). All patients underwent surgical repair of an aortoenteric fistula, with graft removal and replacement in situ using silver impregnated prosthesis. RESULTS: The 30-day mortality rate after surgical treatment of SAEF was 37.5% (9 patients). Causes of death included: hemorrhagic shock, multi-organ failure and myocardial infarction. The early complications after the surgical repair of an aortoenteric fistula occurred in 19 (79.2%) patients. Mortality during the one-year follow-up period was 38.5% (5 patients) and the one-year complication rate was 69.2%. CONCLUSIONS: Each patient with a history of abdominal aortic graft implementation and presenting symptoms of gastrointestinal bleeding requires careful diagnosing for aortoenteric fistula. New methods of surgical treatment offering lower mortality should be developed.
Authors: Sasan Partovi; Thomas Trischman; Rahul A Sheth; Tam T T Huynh; Jon C Davidson; Anand M Prabhakar; Suvranu Ganguli Journal: Cardiovasc Diagn Ther Date: 2018-04