Secondary Arterioenteric Fistulation – A Systematic Literature Analysis

Abstract

Secondary arterioenteric fistula continues to be an extremely serious complication after surgery on aorta and its branches. Every effort must be made to arrive at a rapid diagnosis. The best therapeutic option seems to be axillobifemoral revascularization and subsequent graft removal, which however, requires haemodynamically stable patients. Endovascular repair may serve as a bridge to open surgery.

Secondary Aortoenteric Fistula After Abdominal Aortic Graft Implementation in Our Own Material

“…The use of silverimpregnated graft shortens the operation time and, currently, is a widely accepted technique. The perioperative mortality rate in our patients was 37.5% and was similar to the rate reported by Bergqvist et al [13] (38-47%) referring to the type of surgery we performed. In another systematic review, Aguilar et al reported even lower early mortality rate of 8-13.3% [32].…”

“…In another systematic review, Aguilar et al reported even lower early mortality rate of 8-13.3% [32]. The perioperative mortality rates for the most popular method globally (graft removal and axillobifemoral bypass) reported by the same authors were 42-51% [13] and 18.2-44% [32], respectively. Infection factors play a significant role in the pathogenesis of SAEF.…”

“…Currently, it is considered that the stent graft is the source of infection, so it is recommended to remove the graft and, if possible, implant the prosthesis [34]. Axillobifemoral bypass and graft removal is associated with the relatively lowest mortality rate (31%) according to Bergqvist et al [13], but such a surgical procedure is only possible in hemodynamically stable patients. Deshpande et al [35] described a promising method of endovascular SAEF repair in which the patient is hemodynamically stabilized to allow surgeons time for the implementation of an extra-anatomic bypass and correct fistula repair.…”

“…Angiography was performed in 4 patients and SAEF was diagnosed in 2 cases. Even contrast enhanced CT, which is the most accurate procedure (79% accuracy according to Bergqvist et al) [13], rarely allows for imaging of the aortoenteric fistula. The diagnostic procedure was focused on indirect radiology symptoms which, with reference to the clinical presentation of a patient, most frequently may suggest the presence of an aortoenteric fistula: air in periaortic tissues later than 4 weeks following aortic surgery, focal thinning of the intestinal wall, absence of tissue between the aortic wall and the intestine, liquid in periaortic tissues or their swelling later than 3 months following aortic surgery.…”

“…require surgery, which is the only definitive treatment, but associated with a high mortality rate of between 18.8-59% [13][14][15]. The aim of our study was to review the clinical presentation, diagnosis and postoperative course of patients with aortoenteric fistulas following vascular operations on the abdominal aorta in the years 2000-2014.…”