[Treatment of prostheto-digestive using arterial allograft]

From October 1988 to March 1995, we operated 22 patients for fistulization between the prosthesis and the digestive tract to remove the in situ allograft. The delay between the initial operation and treatment for fistulization was 7.3 +/- 4 years. In these patients who had undergone multiple operations (2.5 +/- 1.9 operations per patient), the infected prosthesis was made of Dacron in 21 cases and polytetrafluoroethylene in one. The procedure was planned beforehand in 21 cases who benefited from a complete preoperative work-up and was required in an emergency situation in 6 for digestive bleeding (5 cases) or an abscess of the Scarpa (1 case). Among the patients with an emergency operation, three of the procedures were conducted within a single operative time and three with two separate procedures. The allografts were aorto-aortic tubes (n = 3), aortobifemoral bypasses (n = 14), aorto-iliac bypasses (n = 4) and one aorto-femoral-iliac bypass. Organ revascularization was associated in 8 patients. Seven patients (32%) died post-operatively. Five of them had undergone an emergency procedure. An amputation was required in 2 patients, one at the time the allograft was implanted and the second due to ischaemia despite a permeable allograft. None of the patients had to be amputated due to failure of the allograft. Mean follow-up was 36.6 +/- 20 months. There were 4 deaths post-operatively due to digestive bleeding in 2. The aortic allograft was dilated in 4 patients without re-operation. Thrombosis of the allograft branch occurred in 4 patients, including 3 who had been re-operated successfully. Despite these still perfectable results, treatment of secondary digestive-prosthesis fistulae with an in situ allograft constitutes a real progress in terms of patient survival and preservation of the limb in high-risk patients.