In situ reconstruction with autologous graft in the treatment of secondary aortoenteric fistulas: A retrospective case series

Abstract

Infections caused by secondary aortoenteric fistulas (SAEF) may be extremely complex and threaten patient's life. We report our surgical approach to SAEF consisting in removal of the infected graft and in situ reconstruction using an autologous venous graft.Seven consecutive patients with SAEF treated with graft removal and in situ reconstruction using an autologous venous graft from 2008 to 2017 were reviewed. Six of seven patients (86%) survived 30-day. In one case a graft thrombosis and acute lower limb ischemia occurred requiring re-operations. All patients received injective antibiotic therapy for 20 days, followed by oral therapy for 3 months. There were no major complications at long-term follow-up.Our results suggest that superficial femoral vein reconstruction of the abdominal aorta for SAEF is effective with an acceptable in-hospital mortality and low rate of major complications. We stress the importance of the deep femoral veins to create the graft because the large saphenous vein is often affected by significant intimal hyperplasia that can cause steno-occlusive complications.

The Challenges of diagnosing and managing a ruptured abdominal aortic aneurysm with primary aortoduodenal fistula.

“…The rarity of the disease has led to a paucity of high quality large or long term studies meaning that the choice of surgical approach remains controversial 21 and will of course depend on the presentation and patient. Extraanatomic bypass with aortic ligation has been the historical gold standard but this is being increasingly challenged by various in situ methods of maintaining perfusion 22 . Some consider a multiple step approach -for example patching the aorta and repairing the duodenum and scheduling elective AAA repair -to put the patient at lower risk of infection than a single definitive surgery 3 .…”

Emergent percutaneous chimney endovascular aortic repair of a secondary aortoenteric fistula in the setting of a solitary kidney

“…Definitive therapy consists of graft excision with extra-anatomic bypass or in situ reconstruction in addition to bowel repair. 1 , 2 , 3 Such a major operative undertaking in patients who commonly present with hemorrhagic and/or septic shock often carries dismal results. Mortality ranges from 21% to 47% at 30 days, with higher rates noted in hemodynamically unstable patients.…”