title: Repair of aortoenteric fistula secondary to graft placement for middle aortic syndrome.
abstract: When an aortoenteric fistula (AEF) arises secondary to suprarenal or more proximal aortic repair, mortality and the complexity of the surgery increases. We present the first reported case to our knowledge of a secondary AEF arising 13 years after surgical repair of middle aortic syndrome. We performed the original surgery on a 22-year-old male who presented with hypertension and claudication by placing a Dacron prosthetic patch on the juxtarenal and infrarenal aorta, bilateral vein bypasses to the left and right renal artery, and a Dacron bypass to the proximal superior mesenteric artery. Thirteen years later, he presented with massive gastrointestinal bleeding and syncope. We performed a distal descending thoracic aortic rifampin-soaked bifurcated Dacron graft to the left renal artery and to a large meandering mesenteric artery followed by excision of all previous prosthetic graft and insertion of a rifampin-soaked tube graft from the distal descending thoracic aorta to the distal abdominal aorta with omental flap coverage. After a complicated postoperative course, he was discharged 2 months later and remains on dialysis at his 6-month postoperative follow-up without evidence of recurrent infection.
authors.affiliation: Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA.
authors.forename: Hong
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Troutman
authors.affiliation: Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Dougherty
authors.affiliation: Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA. Electronic address: Kcalligaro@aol.com.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Calligaro
mesh_terms: D000328:Adult; D001018:Aortic Diseases / Q000175:diagnosis / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D020878:Device Removal; D004378:Duodenal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D011474:Prosthesis Design; D012086:Reoperation; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*