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Aortoenteric fistulas: a preventable problem?

E Puglia, P D Fry

    Canadian Journal of Surgery. Journal Canadien De Chirurgie
    |January 1, 1980
    PubMed
    Summary
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    Secondary aortoenteric fistula, a complication of aortic bypass grafting, can potentially be prevented by ensuring adequate separation between the aortic suture line and the gastrointestinal tract. Early suspicion and diagnosis are crucial for management.

    Area of Science:

    • Vascular Surgery
    • Gastroenterology
    • Surgical Complications

    Background:

    • Secondary aortoenteric fistula is a rare but serious complication following aortic bypass grafting.
    • It often presents with gastrointestinal hemorrhage, ranging from sudden massive bleeding to intermittent episodes.
    • Adequate coverage of synthetic grafts did not prevent fistula formation in most cases.

    Purpose of the Study:

    • To review the management of secondary aortoenteric fistula in 22 patients.
    • To determine preventive strategies for this complication.
    • To evaluate the effectiveness of different management approaches.

    Main Methods:

    • Retrospective review of 22 patients diagnosed with secondary aortoenteric fistula.
    • Analysis of patient history, presentation, diagnostic modalities, and management outcomes.

    Related Experiment Videos

  • Focus on surgical techniques, graft coverage, and anastomosis sites.

    • Main Results:

    • Fistula formation occurred despite adequate synthetic graft coverage in 14 patients.
    • Eighty-one percent of fistulas occurred at anastomosis sites.
    • Overall mortality was 60%, with operative mortality at 47%; successful definitive management involved graft removal and extra-anatomic bypass.

    Conclusions:

    • Secondary aortoenteric fistula is associated with high morbidity and mortality.
    • Endoscopy is a key diagnostic tool, but clinical suspicion is paramount.
    • Preventive measures, specifically separating the aortic suture line from the small bowel and duodenum, are crucial.