Secondary aortoenteric fistula. A 20 year experience

Area of Science:

• Vascular Surgery
• Gastroenterology
• Infectious Disease

Background:

• Secondary aortoenteric fistula (SAf) is a rare but serious complication after aortic reconstructive surgery.
• It often presents with gastrointestinal bleeding, sepsis, or abdominal pain, frequently years after the initial procedure.
• Patients often have coexisting advanced cardiovascular disease.

Purpose of the Study:

• To review the diagnostic and management strategies for secondary aortoenteric fistula.
• To evaluate the outcomes of different surgical approaches for SAf repair.
• To identify factors associated with successful treatment and improved patient survival.

Main Methods:

• Retrospective review of 17 patients treated for SAf at Johns Hopkins Medical Institutions over 20 years.
• Analysis of diagnostic methods including esophagogastroduodenoscopy, aortography, barium studies, and sinography.
• Evaluation of surgical interventions, focusing on graft management and revascularization techniques.

Main Results:

• The average time from initial surgery to SAf symptom onset was 2.8 years.
• High operative mortality (47%) was observed.
• Graft excision with axillofemoral bypass was the only successful repair strategy, whereas leaving grafts in the retroperitoneum led to poor outcomes, including recurrent fistulas.

Conclusions:

• A high index of suspicion is crucial for diagnosing SAf.
• Surgical management must prioritize graft excision and extra-anatomic bypass (axillofemoral bypass) for successful repair.
• Retroperitoneal graft placement is associated with high rates of recurrence and failure.