Secondary aortoenteric fistulae--changes from 1973 to 1993.
OBJECTIVE
To investigate a series of patients with secondary aortoenteric fistulas and compare it with a previous series (1985-93 vs. 1973-84).


METHODS
Retrospective study of medical records.


METHODS
Sixteen vascular surgical centers in Sweden.


METHODS
Twenty-seven patients were identified making an overall incidence of 0.5% of all aortoiliac operations. Among aneurysm patients the incidence was significantly lower than in the previous series. One patient record could not be identified. Fourteen primary operations were for aortic aneurysm, 12 for occlusive disease and one was an aortorenal vein bypass.


RESULTS
Symptoms of the fistula occurred after a median interval of 90 months which is significantly later than the previous series (32 months; p<0.05). The commonest presentation was bleeding followed by septis. The median diagnostic delay was 10.5 days, which was significantly shorter than in the previous series. Most fistulas involved the duodenum (88%). One patient died before surgery. The postoperative mortality was 28%, significantly lower than in the previous series (58%) (p<0.05). At the end of follow up (median 43 months) significantly more patients were alive than in the previous series (42% vs 18%) (p<0.05).


CONCLUSIONS
Over a 21 year period there seems to have been a decrease in the frequency of secondary aortoenteric fistulas after aneurysm surgery, a longer interval before they occur, a shorter diagnostic delay, and a better survival.
Bergqvist
D
D
Department of Surgery, University Hospital, Uppsala, Sweden.
Björkman
H
H
Bolin
T
T
Dalman
P
P
Elfström
J
J
Forsberg
O
O
Johansen
L
L
Karacagil
S
S
Karlqvist
P A
PA
Länne
T
T
Plate
G
G
Ribbe
E
E
Spangen
L
L
Stenbaek
J
J
Thomsen
M
M
Wiklund
B
B
Angquist
K A
KA
D001012:Aorta, Abdominal / Q000601:surgery; D001018:Aortic Diseases / Q000150:complications / Q000453:epidemiology*; D004378:Duodenal Diseases / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005402:Fistula / Q000150:complications / Q000453:epidemiology*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D015994:Incidence; D007412:Intestinal Fistula / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors