Late gastrointestinal bleeding after infrarenal aortic grafting: a 16-year experience.
OBJECTIVE
To review the manifestation and management of gastrointestinal (GI) bleeding caused by secondary aortoenteric fistula (AEF) after infrarenal aortic grafting.


METHODS
Between 1991 and 2006, nine patients underwent emergency treatment for secondary AEF localized in the duodenum (78%), ileum (11%), or sigmoid colon (11%). Three (33%) patients suffered hypovolemic shock. There were two (22%) real fistulas and seven (78%) paraprosthetic fistulas. Graft infection was confirmed in four (45%) patients and four (45%) had proximal sterile pseudoaneurysms. Surgical management consisted of graft removal with (n = 5) or without simultaneous extra-anatomic bypass (n = 1), in situ Dacron graft interposition (n = 3), ileo-duodenorrhaphy (n = 8), sigmoidectomy with colostomy (n = 1), and segmentary ileectomy (n = 1). Endografting was used only as a temporary measure to control bleeding in two patients.


RESULTS
The mortality rate was 55% (n = 5). There were no intraoperative deaths, but 75% of the septic patients, 66% of those with preoperative hemodynamic instability, 50% of those with pseudoaneurysms, and 100% of those who required bowel resection died during the early postoperative period. Moreover, all of the surviving patients suffered early postoperative morbidity, resulting in prolonged intensive care unit stay and hospitalization.


CONCLUSIONS
Secondary AEF is life-threatening, difficult to treat, and associated with high morbidity and mortality, especially in patients with sepsis or hemodynamic instability and those requiring bowel resection.
Bianchi
Paolo
P
Department of Vascular Surgery, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, San Donato Milanese, Milan, Italy.
Dalainas
Ilias
I
Ramponi
Fabio
F
Dell'Aglio
Daniela
D
Casana
Renato
R
Nano
Giovanni
G
Malacrida
Giovanni
G
Tealdi
Domenico G
DG
D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D004378:Duodenal Diseases / Q000150:complications / Q000601:surgery; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007077:Ileal Diseases / Q000150:complications / Q000601:surgery; D015994:Incidence; D007412:Intestinal Fistula / Q000150:complications / Q000601:surgery; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000150:complications / Q000601:surgery; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016157:Vascular Fistula / Q000150:complications / Q000601:surgery