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Aortointestinal fistulae following aortic reconstruction
The Australian and New Zealand Journal of Surgery
|December 1, 1982
Summary
Aortointestinal fistula, a rare complication after aortic reconstruction, presents with gastrointestinal bleeding. Early graft removal and revascularization are crucial for effective surgical management and improved patient outcomes.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Surgical Complications
Background:
- Aortointestinal fistula is a rare but serious complication following aortic reconstruction.
- It often presents with significant gastrointestinal bleeding and can have infective components.
Purpose of the Study:
- To report the incidence and management of aortointestinal fistula at a single institution.
- To highlight the diagnostic challenges and outcomes associated with this condition.
Main Methods:
- Retrospective review of six patients treated for aortointestinal fistula over a decade.
- Analysis of clinical presentation, investigations, surgical management, and outcomes.
Main Results:
- An incidence of 0.8% following aortic reconstruction was observed.
- All patients presented with gastrointestinal bleeding; two had associated infections.
- Preoperative investigations were diagnostic in only 50% of cases.
- Mortality was 50% (three patients) directly due to the fistula.
- Graft removal and revascularization were associated with better outcomes; two of three patients without graft removal experienced later complications.
Conclusions:
- High index of suspicion is essential for diagnosing aortointestinal fistula in patients with prior aortic surgery presenting with gastrointestinal bleeding.
- Surgical management necessitates graft explantation and prompt revascularization to improve survival and prevent further complications.