Aortoenteric fistula. A 7 year urban experience

Area of Science:

• Vascular Surgery
• Gastroenterology
• Diagnostic Imaging

Background:

• Aortoenteric fistulas are rare but life-threatening complications following aortic surgery.
• Secondary aortoenteric fistulas (SAFs) represent a significant challenge in surgical management.
• Understanding risk factors and optimal treatment is crucial for improving patient outcomes.

Purpose of the Study:

• To review the clinical presentation, diagnostic methods, and surgical outcomes of patients with aortoenteric fistulas.
• To identify risk factors associated with the development of secondary aortoenteric fistulas.
• To evaluate the long-term survival and recurrence rates after surgical intervention.

Main Methods:

• Retrospective review of operative records from teaching hospitals over a 7-year period.
• Analysis of 28 patients diagnosed with aortoenteric fistulas, with a focus on 25 secondary cases.
• Evaluation of diagnostic modalities and surgical treatment strategies.

Main Results:

• Eighty percent of secondary aortoenteric fistula patients experienced a "herald bleed."
• Diagnostic maneuvers, except for endoscopy, CT, or ultrasound, were largely ineffective.
• Initial survival was 60%, but long-term survival dropped to 36% due to recurrent aortic complications.

Conclusions:

• Complex or repeated aortic operations, including prior fistula repair, increase the risk of developing new aortoenteric fistulas.
• Graft excision, aortic ligature, and extraanatomic bypass remain the standard surgical therapy.
• Serial screening with noninvasive imaging (ultrasound, CT) may be beneficial for high-risk patients.