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Aortic graft-enteric fistula and paraprosthetic-enteric fistula: a review
Insights
Aortoesophageal and aortopulmonary fistulas (AGEF/PPEFs) are rare but fatal surgical complications. Suspect these fistulas in patients with aortic prostheses presenting with gastrointestinal bleeding or sepsis for prompt diagnosis and management.
Area of Science:
- Vascular Surgery
- Surgical Complications
- Gastrointestinal Surgery
Background:
- Aortoesophageal and aortopulmonary fistulas (AGEF/PPEFs) are infrequent but life-threatening complications following aortic reconstructive surgery.
- Early diagnosis is critical and necessitates a high index of suspicion.
Purpose of the Study:
- To highlight the diagnostic challenges and management strategies for AGEF/PPEFs.
- To emphasize the importance of prompt recognition in patients with aortic prostheses.
Main Methods:
- Clinical case review and analysis of diagnostic indicators.
- Review of surgical outcomes and management protocols for AGEF/PPEFs.
Main Results:
- Gastrointestinal bleeding or sepsis in patients with aortic prostheses strongly suggests a fistulous complex.
- Surgical management typically involves graft excision and extraanatomic bypass.
Conclusions:
- Prompt diagnosis and surgical intervention are crucial for managing AGEF/PPEFs.
- Widespread retroperitoneal infection often contraindicates local revascularization, favoring extraanatomic bypass.
Abstract:
AGEF/PPEFs are infrequent, life-threatening complications of aortic reconstructive surgery. Early diagnosis requires a high index of suspicion. Whenever a patient with an aortic prosthesis develops gastrointestinal bleeding or manifestations of sepsis, the presence of a fistulous complex should be assumed until proven otherwise. In the vast majority of cases, adequate surgical management requires graft excision with extraanatomic bypass. Widespread retroperitoneal infection precludes any attempt at local revascularization.