TREATMENT OF AORTOENTERIC FISTULA BY ARTE RIAL ALLOGRAFT

From October 1988 to March 1995, we operated 22 patients for fistuliza tion between the prosthesis and the digestive tract to remove the ill sinl allograft. The delay between the initial operation and treatment for fistulization was 7.3 +/- 4 years. In these patients who had under gone multiple operations (2.5 +/- 1.9 operations per patient), the inf ected prosthesis was made of Dacron in 21 cases and polytetrafluoroeth ylene in one. The procedure was planned beforehand in 21 cases who ben efited from a complete preoperative work-up and was required in an eme rgency situation in 6 for digestive bleeding (5 cases) or an abscess o f the Scarpa (1 case). Among the patients with an emergency operation, three of the procedures were conducted within a single operative time and three with two separate procedures. The allografts were aorto-aor tic tubes (n = 3), aortobifemoral bypasses (n = 14), aorto-iliac bypas ses (n = 4) and one aorto-femoral-iliac bypass. Organ revascularizatio n was associated in 8 patients. Seven patients (32 %) died post-operat ively. Five of them had undergone an emergency procedure. An amputatio n was required in 2 patients, one at the time the allograft was implan ted and the second due to ischaemia despite a permeable allograft. Non e of the patients had to be amputated due to failure of the allograft. Mean follow-up was 36.6 +/- 20 months. There were 4 deaths post-opera tively due to digestive bleeding in 2. The aortic allograft was dilate d in 4 patients without re-operation. Thrombosis of the allograft bran ch occurred in 4 patients, including 3 who had been re-operated succes sfully. Despite these still perfectable results, treatment of secondar y digestive-prosthesis fistulae with an in situ allograft constitutes a real progress in terms of patient survival and preservation of the l imb in high-risk patients.