title: Aorto-enteric fistula: changing management strategies.
abstract: 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.
authors.affiliation: Dept of Vascular Surgery, St Vincent's University Hospital, Dublin.
authors.forename: D O
authors.initials: DO
authors.lastname: Kavanagh
authors.forename: J F
authors.initials: JF
authors.lastname: Dowdall
authors.forename: F
authors.initials: F
authors.lastname: Younis
authors.forename: S
authors.initials: S
authors.lastname: Sheehan
authors.forename: D
authors.initials: D
authors.lastname: Mehigan
authors.forename: M C
authors.initials: MC
authors.lastname: Barry
mesh_terms: 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*