Revascularization and Digestive Tract Repair in Secondary Aortoenteric Fistula Using a Single-Center in Situ Revascularization Strategy

• Published in: Annals of vascular surgery Vol. 101; pp. 148 - 156
• Main Authors: Akamatsu, Daijirou, Serizawa, Fukashi, Umetsu, Michihisa, Suzuki, Shunya, Goto, Hitoshi, Unno, Michiaki, Kamei, Takashi
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.04.2024
• Subjects: Aortic Diseases - complications; Aortic Diseases - diagnostic imaging; Aortic Diseases - surgery; Blood Vessel Prosthesis - adverse effects; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - methods; Duodenum - surgery; Humans; Intestinal Fistula - diagnostic imaging; Intestinal Fistula - etiology; Intestinal Fistula - surgery; Male; Retrospective Studies; Treatment Outcome; Vascular Fistula - diagnostic imaging; Vascular Fistula - etiology; Vascular Fistula - surgery
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2023.10.028

Information regarding optimal revascularization and digestive tract repair in secondary aortoenteric fistula (sAEF) remains unclear. Thus, reporting treatment outcomes and presenting comprehensive patient details through a structured treatment approach are necessary to establish a treatment strategy for this rare, complex, and fatal condition. We performed a single-center retrospective review of consecutive sAEF managed based on our in situ revascularization and intestinal repair strategy. The primary endpoint of this study was all-cause mortality, and secondary endpoints were the incidence of in-hospital complications and midterm reinfections. Between 2007 and 2020, 16 patients with sAEF, including 13 men (81%), underwent in situ revascularization and digestive tract repair. The median follow-up duration for all participants was 36 (interquartile range, 6–62) months. Among the participants, 81% (n = 13), 13% (n = 2), and 6% (n = 1) underwent aortic reconstruction with rifampin-soaked grafts, unsoaked Dacron grafts, and femoral veins, respectively. The duodenum was the most commonly involved site in enteric pathology (88%; n = 14), and 57% (n = 8) of duodenal breaks were repaired by a simple closure. Duodenum’s second part–jejunum anastomosis was performed in 43% of patients (n = 6), and 19% of the patients (n = 3) died perioperatively. In-hospital complications occurred in 88% patients (n = 14), and the most frequent complication was gastrointestinal. Finally, 81% patients (n = 13) were discharged home. Oral antibiotics were administered for a median duration of 5.7 months postoperatively; subsequently, the participants were followed up carefully. Reinfection was detected in 6% of the patients (n = 1) who underwent reoperation without any complications. The 1-year and 3-year overall survival rates of participants were 75% (n = 12) and 75% (n = 9), respectively, and no sAEF-related deaths occurred, except perioperative death. Surgical intervention with contemporary management based on our vascular strategy and digestive tract procedure may be a durable treatment for sAEF.