Aorto-enteric fistulas as postoperative complication.

This report is based on 15 own observations and 164 patients collected from the literature. The most frequent location both of primary and secondary aortic-enteric fistulas (AEF) is the end part of the duodenum (60-70%). In the group of secondary AEF the paraprosthetic type represents the most frequent morphological finding. The best diagnostic approach should be seen in a gastroduodenoscopy. The choice of surgical repair is still controversal. Most of the surgeons insist on a radical repair (Type A: restoration of the intestinal tract, complete removal of the vascular prosthesis, blind closure of the infrarenal aortic stump, axillo-bifemoral bypass). Type A repair is loaded with a high operative mortality (52%) and a number of secondary complications (e.g. recurrent AEF; bleeding from the aortic stump). As an alternative surgical approach the author present an in-situ-repair (Type B: closing of the intestinal defect, partial exchange of inserted vascular prosthesis, an encircling omentum sleeve covering the prosthesis and anastomoses). The Type B repair offers a time saving procedure with a reduced operative mortality (26%) and a better outcome for the patients. This method is only contraindicated in the presence of a spread infection of the retroperitoneal space including the vascular prosthesis.