Late outcome following open surgical management of secondary aortoenteric fistula

Abstract

The long-term outcomes associated with aortoenteric fistula repair might be favourable when silver-impregnated grafts were used as an in situ strategy. The eradication of infection is possible in mid-term follow-up with partial graft replacement, which associated with a lesser operative load.

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections

“…For large perigraft abscesses and MRSA infections, EAR and removal of the infected graft may be considered. 17,146,151,176,177,180 7.2.5. Partial or total excision of the material.…”

“…140 In several studies, no difference in outcome was seen between patients with partial resection and complete resection. 146,198 The only factor influencing the re-infection rate (47%) was the length of follow up, led to the conclusion that lifetime follow up was mandatory. 198 Mortality after reinfection was 100%.…”

“…Mortality rates relate to: (i) the patient's condition e an American Society of Anaesthesiology score 4 and sepsis are independant risk factors for mortality, 145,154 as well as individual local presentation of infection affect the outcome; (ii) the emergency or elective setting e there is higher 30 day mortality in emergency settings; 146 (iii) the presence of an AEnF e studies that included AEnF resulted in worse outcome; 198 (iv) virulence of the micro-organisms e operative mortality rate was higher in abdominal aortic VEGI caused by virulent microorganisms. 17,144,145,156,157,180 MRSA and multiresistant strains are associated with poor outcome.…”

Imaging work-up and endovascular treatment options for aorto-enteric fistula

“…There has not been a direct comparison of infection associated with open surgical repair versus endovascular repair of AEF to date to the best of our knowledge. The rate of infection in survivors of open surgical repair of AEF after a 9-month follow-up was 25% (38). It is possible that the rate of infection following surgical repair is slightly lower than that following endovascular repair because open surgery allows for debridement of infected tissue and removal of infected grafts.…”

The First Case of a Nellix Sac-Anchoring Endoprosthesis Removal for Aortoenteric Fistula

“…Treatment alternatives consist in graft excision and extra-anatomic bypass; graft excision and "in situ" reconstruction with homologous vein bypass grafting or silver Dacron prosthesis. 14,15 In recent years, even endovascular repair has emerged as another therapeutic option, particularly for the rapid control of bleeding from AEF. 16 In the present case an endovascular approach was deemed impossible, even as a "bridge therapy", considering that Nellix device system doesn't allow to perform endovascular repair of a type I proximal endoleak.…”