title: [Abdominal secondary aorto-enteric fistulae complicating aortic graft replacement: postoperative and long-term outcomes in 32 patients].
abstract: Management of patients with abdominal secondary aorto-entericfistulae (SAEF) complicating aortic graft replacement is controversial. We retrospectively analyzed the postope- rative and long-term outcomes of all consecutive patients operated on for SAEF betwveen 2002 and2012. All were managed by in situ replacement with a cryopreserved allograft and treatment of the affected digestive tract. Thirty-two patients (median age 65 years) underwent aortic replacement for SAEFa median of 5 years after initial aortic surgery. The fistulae were located in the duodenum (n = 20), small bowel (n = 6), colon (n = 5) or stomach (n = 1). Treatment of the digestive tract included suture (n = 16), resection with anastomosis (n = 12) covered by a defunctioning stoma (n = 1), and Hartmann's procedure (n = 3). Omentoplasty was performed in 18 patients (56 %), and 17 patients (53 %) had afeedingjejunostomy. Eight patients (25 %) died post-operatively, 3 with a recurrent aorto-enteric fistula. Fifteen (62.5 %) of the remaining patients developed 27 complications, including 6 patients (19 %) with severe morbidity (Dindo III-IV). The reoperation rate was 21 %. The median hospital stay was 33 days. During follow-up (median 15 months), no further patients had a recurrent aorto-enteric fistula. We conclude that surgery for SAEF is a major procedure associated with high mortality and morbidity. Good long-term results can be obtained by excision of the prosthetic graft with cryopreserved allograft replacement, and by management in a tertialy referral center with expertise in both vascular and digestive surgery.
authors.forename: Jean-christophe
authors.initials: JC
authors.lastname: Vaillant
authors.forename: Thibaut
authors.initials: T
authors.lastname: Schoell
authors.forename: Mehdi
authors.initials: M
authors.lastname: Karoui
authors.forename: Laurent
authors.initials: L
authors.lastname: Chiche
authors.forename: Julien
authors.initials: J
authors.lastname: Gaudric
authors.forename: Hadrien
authors.initials: H
authors.lastname: Gibert
authors.forename: Christophe
authors.initials: C
authors.lastname: Tresallet
authors.forename: Fabien
authors.initials: F
authors.lastname: Koskas
authors.forename: Laurent
authors.initials: L
authors.lastname: Hannoun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D001012:Aorta, Abdominal / Q000601:surgery; D001018:Aortic Diseases / Q000209:etiology* / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D015897:Comorbidity; D013505:Digestive System Surgical Procedures; D005260:Female; D005402:Fistula / Q000209:etiology* / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology* / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D012189:Retrospective Studies; D012772:Shock, Septic / Q000453:epidemiology / Q000382:microbiology; D013536:Suture Techniques; D016896:Treatment Outcome