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Aortoenteric fistula

J E Connolly, J H Kwaan, P M McCart

    Annals of Surgery
    |October 1, 1981
    PubMed
    Summary
    This summary is machine-generated.

    Preventing aortoenteric fistula is crucial due to high mortality. Key strategies include protecting grafts from the gut and prompt graft removal if infection occurs, improving patient outcomes.

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    Area of Science:

    • Vascular Surgery
    • Gastrointestinal Surgery
    • Infectious Disease

    Background:

    • Aortoenteric fistula presents a high mortality risk, necessitating a re-evaluation of prevention and management strategies.
    • Understanding the pathophysiology and predisposing factors is essential for improving patient survival rates.
    • This study analyzes 31 cases to refine current clinical practices.

    Observation:

    • Adequate protection between the aortic graft and the gastrointestinal tract is paramount for prevention.
    • Techniques include using tissue interposition, prosthetic cuffs, and proper reperitonealization.
    • Systemic or groin infections require immediate graft removal to avert fistula formation.

    Findings:

    • Early diagnosis of paraprothestic aortoenteric fistulas relies on clinical suspicion, fever, and positive blood cultures.

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  • Advanced imaging like CT and Gallium 67 scans aid in early detection.
  • Surgical intervention involves graft removal, meticulous closure of aortic and enteric openings, and sump drainage.

    • Implications:

    • Prompt surgical management, including graft removal and reconstruction, is indicated once aortoenteric fistula is diagnosed.
    • Extra-anatomic bypass or endarterectomy may be required to restore limb perfusion.
    • Despite improved management, significant late mortality remains a concern, underscoring the importance of prevention.