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Aorto-enteric fistula: changing management strategies
D O Kavanagh1, J F Dowdall, F Younis
1Dept of Vascular Surgery, St Vincent's University Hospital, Dublin.
Irish Journal of Medical Science
|April 18, 2006
Summary
Management of aorto-enteric fistulae has evolved. In situ revascularization and local repair offer better outcomes than traditional extra-anatomic bypass, reducing mortality and limb loss in complex cases.
Area of Science:
- Vascular Surgery
- Gastrointestinal Surgery
Background:
- Aorto-enteric fistulae traditionally treated with extra-anatomic bypass and graft excision, leading to high limb loss (10-40%) and mortality (10-70%).
- In situ revascularization is a more recent, advocated approach.
Purpose of the Study:
- To review the changing management strategies for aorto-enteric fistulae over a 22-year period.
- To evaluate the outcomes associated with different surgical approaches.
Main Methods:
- Retrospective analysis of demographic, clinical, operative, and pathological data.
- Inclusion of 21 patients diagnosed with aorto-enteric fistulae.
Main Results:
- Extra-anatomic bypass group: 60% mortality, 40% limb loss.
- In-situ revascularization group: 25% mortality.
- Primary repair group: 25% mortality.
- Overall survival rate: 38%; postoperative survival rate: 60%.
Conclusions:
- Surgical techniques for aorto-enteric fistulae are evolving towards local approaches.
- Prolonged, intensive postoperative antimicrobial therapy is part of the current trend.
- The local surgical approach has demonstrated acceptable outcomes in this experience.