Lessons learnt in the management of aortoenteric fistulae

Secondary aortoenteric fistula may be treated directly by local repair or by excision of all prosthetic material with extra-anatomic revascularisation. We have reviewed our experience with 14 aorto-enteric fistulae encountered between 1960 and 1984. Two patients who were not treated surgically died. Direct repair was attempted in seven patients, two of whom had no prosthetic material present and survived. Five patients had prosthetic grafts which were not removed and four died from recurrent aortic haemorrhage. There were five other patients who had prosthetic grafts which were removed prior to extra-anatomic reconstruction. Three of these died in the peri-operative period, two from sepsis but only one from aortic stump bleeding. The operative mortality was 58%. The overall survival was only 36% (5 of 14 patients) but there was less chance of recurrent aortic haemorrhage when all prosthetic graft material was removed and direct repair avoided.