Aortoenteric fistula.

Because of the unacceptably high mortality rate associated with aortoenteric fistula, we have constantly re-evaluated our experience with this lesion. A study of 31 cases of aortoenteric fistula proven at operation has provided a better understanding of the prevention and management of aortoenteric fistula. Prevention remains the primary goal, as the treatment of this complication even with the adoption of recommendations made in our paper can be expected to continue to carry a significant late mortality rate. The most important point in prevention is to provide adequate protection between gut and graft, using tissue, prosthetic cuff and correct reperitonealization techniques. Systemic or groin infection should be followed by prompt total removal of the graft before the onset of aortoenteric fistula. Once aortoenteric fistula is present, early operation with removal of the graft, proper closure of the aortic and enteric openings, and sump drainage of the area is indicated. Blood supply to the extremities is supplied by extra-anatomic bypass or endarterectomy if the underlying problem is arterial occlusive disease. Paraprosthetic aortoenteric fistulas may be diagnosed early by the presence of fever, blood culture, and a high degree of suspicion. CAT and gallium 67 scanning can be helpful in identifying this early type of fistula.