TREATMENT OF SECONDARY AORTOENTERIC FISTU LA - IN-SITU GRAFT REPLACEMENT

Secondary aorto-enteric fistula is one of the most serious complicatio ns of abdominal aortic reconstruction. Conventional management include s removal of all infected prosthetic graft, oversewing of aortic stump and restoration of lower limbs blood flow by extraanatomic bypass gra fting, reporting high rates of mortality, limb loss, and even infectio n of the extraanatomic grafts. Dissatisfied by these results, frequent ly, due to aortic stump blowout or extraanatomic by-pass reinfection, some authors attempted a more conservative approach with au in situ re placement by a new synthetic graft. The aim of this paper was to verif y the role of in situ graft replacement. From December 1989, 8 patient s with secondary aorto-enteric fistula underwent in situ PTFE graft re placement. One patient (12.5 %) died perioperatively for acute myocard ial infarction. No limb loss occured. One patient died after 44 months from pulmonary neoplasia without signs of graft infection. The others are doing well at 34 months follow-up. The authors suggest that, in s elected patients, in situ prosthetic graft replacement provides better early and late results than extraanatomic bypass.