Improved perioperative mortality after secondary aortoenteric fistula repair and lessons learned from a 20-year experience

A Novel Endovascular Treatment for Recurrent Secondary Aorto-Enteric Fistula in a Patient With Prior Infra-Renal Aortic Ligation

“…SAEF is a rare but lethal entity with limited literature and experience in managing this condition. SAEF is estimated to occur in 0.4-4.0% of patients with prior aortic intervention, which is expected to increase with increased detection of aortic disease and the use of aortic prosthetic grafts [3,4]. The gold standard for the treatment of SAEF is surgical repair which involves graft excision, bowel repair, and extra-anatomic bypass (EAB) or in-situ repair (ISR) either as a staged or single procedure [4].…”

“…SAEF is estimated to occur in 0.4-4.0% of patients with prior aortic intervention, which is expected to increase with increased detection of aortic disease and the use of aortic prosthetic grafts [3,4]. The gold standard for the treatment of SAEF is surgical repair which involves graft excision, bowel repair, and extra-anatomic bypass (EAB) or in-situ repair (ISR) either as a staged or single procedure [4]. However, mortality and morbidity of open surgical aortic repair remain high, at 70%, with most complications being GI (30%), pulmonary (25%), and renal (21%) [4].…”

“…The gold standard for the treatment of SAEF is surgical repair which involves graft excision, bowel repair, and extra-anatomic bypass (EAB) or in-situ repair (ISR) either as a staged or single procedure [4]. However, mortality and morbidity of open surgical aortic repair remain high, at 70%, with most complications being GI (30%), pulmonary (25%), and renal (21%) [4]. The rate of recurrence of SAEF after the repair is also estimated at 4% [2].…”

Surgical Science and the Evolution of Critical Care Medicine

“…Other patient populations who continue to suffer hemorrhage-related death include those with ruptured abdominal aortic aneurysms (10,000 U.S. deaths annually), peptic ulcer disease (nearly 2,000 U.S. deaths annually), and peripartum hemorrhage (140 U.S. deaths annually) (27). Other populations such as those with portal hypertension and esophageal varices, and those with more distal gastrointestinal (GI) track hemorrhage (dieulafoy lesions, diverticulosis, and aortoenteric fistula) are important groups who often require critical care and rapid resuscitation from hemorrhagic shock (28)(29)(30). Survival in these patients requires timely diagnosis, early hemostasis, and rapid targeted resuscitation in adults and pediatric populations alike (31)(32)(33)(34).…”

Aortoenteric Fistula: A Differential Diagnosis of Anemia

“…Surgical management often includes excision of the infected or necrotic tissue, repair or replacement of the damaged portion of the aorta, and, if necessary, resection of the affected segment of the intestine [ 10 ]. However, the procedure carries a high risk of complications, including infection and bleeding, as well as a high risk of mortality (10-40%), particularly in cases of significant hemorrhage [ 11 ].…”