Secondary arterio-enteric fistulae: a surgical challenge

Area of Science:

• Vascular Surgery
• Infectious Disease

Background:

• Secondary arterio-enteric fistulae are rare but life-threatening complications following aortic reconstructions.
• Infection of aortic grafts or suture lines can lead to fistula formation, presenting with bleeding or abscesses.

Purpose of the Study:

• To describe the clinical presentation, management, and outcomes of patients with secondary arterio-enteric fistulae.
• To evaluate the effectiveness of surgical interventions, including graft resection and axillofemoral bypass.

Main Methods:

• Retrospective review of ten cases of secondary arterio-enteric fistulae.
• Analysis of patient demographics, presenting symptoms, surgical procedures, microbiological findings, and long-term outcomes.

Main Results:

• Nine cases involved graft-enteric fistulae, and one involved an aortic suture line fistula.
• Eight patients presented with bleeding; two with groin abscesses. Organisms were cultured from six of eight grafts.
• While no patients died intraoperatively, one died postoperatively. Long-term survival was poor, with complications including aortic rupture and recurrent fistulae. Axillofemoral bypass grafts had a high occlusion rate.

Conclusions:

• Secondary arterio-enteric fistulae pose significant management challenges with high morbidity and mortality.
• Aggressive surgical management including graft resection is necessary, but long-term outcomes remain suboptimal.
• Axillofemoral bypass may be a temporizing measure, but its long-term patency in this context is limited.