Outcomes of In-Situ Reconstruction of Secondary Aorto-Enteric Fistulas

Background and PurposeSecondary aorto-enteric fistulas (SAEF) are the most severe form of aortic graft infection, with a mortality of over 50% during the first year after diagnosis.Materials and MethodsA retrospective review of patients treated for SAEF from 2015 to 2021 in University Hospital Centre Zagreb was done to analyze factors that determine the outcome. There were 7 cases of SAEF among 400 cases of open aortic surgery. Mean patient age was 69 years (range 63-88).ResultsFive patients underwent graft removal and in-situ aortic reconstruction using a cryopreserved homograft or a prosthetic Dacron silver graft (Vascutec Gelsoft Plus, Terumo, Tokyo, Japan). In 1 patient direct suture repair of the fistula was done, and the patient underwent recurrent SAEF reconstruction with cryopreserved homograft a year later. There were 3 recurrences of SAEF in 2 patients, 1 case of disruption of the duodenal suture line, and 1 case of cryopreserved graft necrosis and rupture necessitating emergency extra-anatomic bypass. Overall, 1 patient died during surgery (in-hospital mortality 1/7, 15%), and 3 patients are currently alive (follow-up 4-5 years). Overall 1-month survival, 1-year survival and 3-year-survival were 6/7 (85%). All patients received antibiotics for 6 weeks postoperatively.ConclusionThere is no unique, the best, treatment modality proven in the literature for SAEF, so every case should be analyzed for itself. Prolonged antibiotic therapy, complications and re-interventions are common among these patients, so meticulous follow-up is necessary.