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Aortoenteric fistulas.

J J Peck1, L R Eidemiller

  • 1Department of Surgery, Good Samaritan Hospital, Portland, Ore.

Archives of Surgery (Chicago, Ill. : 1960)
|October 1, 1992
PubMed
Summary
This summary is machine-generated.

Aortoenteric fistulas, often arising after aortic reconstruction, present diagnostic challenges and high mortality. Early diagnosis and remote bypass before infected graft removal improve patient outcomes.

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Area of Science:

  • Vascular Surgery
  • Gastrointestinal Surgery

Background:

  • Aortoenteric fistulas are rare but life-threatening complications.
  • Secondary fistulas frequently occur after aortic reconstruction with synthetic grafts.
  • Spontaneous fistulas also present significant management challenges.

Purpose of the Study:

  • To analyze the clinical presentation, diagnosis, and treatment outcomes of aortoenteric fistulas.
  • To identify factors associated with improved survival in patients with aortoenteric fistulas.

Main Methods:

  • Retrospective review of 36 patients treated for aortoenteric fistulas between 1981 and 1991.
  • Analysis of patient demographics, surgical history, diagnostic methods, treatment strategies, and outcomes.
  • Comparison of outcomes based on fistula type (primary vs. secondary) and treatment approach.

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Main Results:

  • Overall mortality was 56%.
  • Preoperative diagnosis was achieved in only 36% of cases.
  • Secondary aortoenteric fistulas were more common (69%), often associated with previous aortic aneurysmal rupture or multiple reconstructions.
  • Remote bypass preceding infected graft removal was associated with lower morbidity and mortality.
  • Positive preoperative blood cultures predicted a poor outcome.
  • Unusual fistula locations included aortocolonic, aortobronchial, and aortoesophageal.

Conclusions:

  • Aortoenteric fistulas pose a significant surgical challenge with high mortality.
  • Improved preoperative diagnostic accuracy and timely, staged surgical intervention are crucial.
  • Remote bypass and graft explantation represent a favorable treatment strategy.