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Published on: April 1, 2022
Secondary arterioenteric fistulation--a systematic literature analysis
1Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden. david.bergqvist@surgsci.uu.se
Summary
Secondary arterioenteric fistulation is a serious complication after aortic surgery. Early diagnosis and treatment, often involving axillobifemoral revascularization and graft removal, are crucial for improving patient outcomes.
Area of Science:
- Vascular Surgery
- Surgical Complications
- Gastrointestinal Surgery
Background:
- Secondary arterioenteric fistulation is a rare but life-threatening complication following aortic and branch surgery.
- It can occur years after the initial procedure, presenting diagnostic challenges.
Purpose of the Study:
- To analyze the incidence, clinical presentation, diagnosis, and outcomes of secondary arterioenteric fistulation.
- To identify optimal management strategies for this severe complication.
Main Methods:
- Systematic literature review of case reports and relevant articles.
- Inclusion of patients from studies focusing on infectious complications after aortic surgery.
Main Results:
- 332 cases and 1135 patients identified, with a median delay of 26 years from surgery to fistula development.
- Hemorrhage was the primary symptom (over 50%), with diagnostic delay being common.
- Mortality rates were high, but appeared to decrease over time, with axillobifemoral revascularization and graft removal showing the best outcomes.
Conclusions:
- Secondary arterioenteric fistula remains a critical complication requiring prompt diagnosis and intervention.
- Axillobifemoral revascularization with graft removal is the preferred treatment for stable patients.
- Endovascular repair can serve as a temporizing measure before open surgery.
