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The management of aortoenteric and paraprosthetic fistulae
R S Higgins1, D L Steed, T B Julian
1Department of General Surgery, University of Pittsburgh, PA.
Insights
Aortoenteric fistulae without infection can be safely repaired locally. Infected aortic paraprosthetic fistulae require graft removal, leading to significant complications and mortality.
Area of Science:
- Vascular Surgery
- Surgical Complications
- Gastrointestinal Surgery
Background:
- Aortoenteric fistulae (AEF) and aortic paraprosthetic fistulae (PPF) are severe complications following aortic reconstructive surgery.
- Current recommendations often involve graft excision and extra-anatomic bypass for these conditions.
Purpose of the Study:
- To review the University of Pittsburgh's experience with AEF and PPF between 1977 and 1987.
- To evaluate treatment strategies and outcomes for these devastating complications.
Main Methods:
- Retrospective review of 15 patients diagnosed with AEF or PPF.
- Analysis of surgical approaches, including local repair, in situ replacement, and extra-anatomic bypass.
- Assessment of operative outcomes, including survival and limb salvage.
Main Results:
- Nine patients had AEF; 6 without graft infection underwent local repair or in situ replacement, all surviving without limb loss.
- Two AEF patients with graft infection required excision and extra-anatomic reconstruction, both succumbing to complications.
- Six PPF patients with overt graft infection underwent excision and bypass; two died from sepsis.
Conclusions:
- AEF without evidence of graft infection can be treated safely with local repair.
- PPF, indicative of infected grafts, necessitates graft removal, associated with substantial morbidity and mortality.
Abstract:
Aortoenteric and aortic paraprosthetic fistulae are devastating complications. Most authors recommend total excision of the graft and revascularization of the lower extremities by extra-anatomic bypass. We reviewed the University of Pittsburgh experience with these fistulae in 15 patients between 1977 and 1987. There were 9 aortoenteric fistulae (AEF) and 6 paraprosthetic fistulae (PPF). Seven of the 9 AEF had no abscess surrounding the graft, but communication of the intestine with the aortic anastomosis. One patient died during operation. Six patients underwent a local repair or in situ replacement of the graft. All 6 of those patients survived operation without limb loss. Two of the 9 patients with AEF had evidence of graft infection and underwent total excision of the graft and extra-anatomic reconstruction. Both patients died, one of sepsis and one of aortic stump rupture. All 6 patients with PPF had clinical and operative evidence of overt graft infection and underwent total graft excision and extra-anatomic bypass. Two of these patients died secondary to sepsis. We conclude that AEF, without evidence of graft infection, were safely treated by local repair. Patients with PPF had infected grafts requiring graft removal with significant morbidity and mortality.