Aortointestinal fistulae following aortic reconstruction

Six patients with aortointestinal fistula have been treated at Royal Prince Alfred Hospital (RPAH) over the last decade. Four had their initial vascular reconstruction at RPAH and two were referred. This represents an incidence of 0.8% following aortic reconstruction at this hospital. All presented with gastrointestinal bleeding (GIT) and two also had infective complications. Preoperative investigations were helpful in only half the patients. Three died as a direct result of the aortointestinal fistula. Later complications occurred in two of three patients where the graft was not removed. The most important aspect of management is suspicion of aortointestinal fistula as a cause for GIT bleeding in a patient with previous aortic surgery. Effective surgical management requires removal of the graft and early revascularization.