Aorto-enteric fistula: changing management strategies.
BACKGROUND
Traditionally treatment of aorto-enteric fistulae involved placement of an extra-anatomic bypass and graft excision. This is associated with limb loss (10-40%) and high mortality (10-70%). More recently in situ revascularisation has been advocated.


OBJECTIVE
To examine our experience with the changing management of aorto-enteric fistulae over a 22-year period.


METHODS
Demographic, clinical, operative and pathological data were recorded retrospectively.


RESULTS
Twenty-one patients were included. Seven had primary fistulae. Six died prior to intervention. Five had an extra-anatomical bypass (60% mortality, 40% limb loss), four had in-situ revascularisation (25% mortality), four had a primary repair (25% mortality) and two had insertion of a tube graft (primary fistulae). The overall survival rate was 38%. The postoperative survival rate was 6o%.


CONCLUSIONS
Techniques for operative management continue to evolve. The current trend is towards a local surgical approach with prolonged and intensive postoperative antimicrobial therapy. In our experience this approach has yielded acceptable outcomes.
Kavanagh
D O
DO
Dept of Vascular Surgery, St Vincent's University Hospital, Dublin.
Dowdall
J F
JF
Younis
F
F
Sheehan
S
S
Mehigan
D
D
Barry
M C
MC
D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery; D001018:Aortic Diseases; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis / Q000601:surgery; D007494:Ireland; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000639:trends*