DIAGNOSIS AND THERAPY OF AORTIC PROSTHETIC FISTULAS - TRENDS OVER A 30-YEAR EXPERIENCE

A retrospective study was carried out of patients from a patients from a single institution over a 30-year period. Thirty-one patients prese nted with 33 fistulas, four non-enteric and 27 enteric. In 25 of 27 pa tients with a prosthesis-related enteric fistula gastrointestinal blee ding was present. Angiography revealed the fistula in five patients, e ndoscopy in three, and barium studies, echography and computed tomogra phy each revealed one fistula. Six patients died before and five died during operation. In 20 patients various techniques were used for trea tment. In-hospital mortality decreased from six of eight patients befo re 1970, to seven of ten between 1971 and 1980, and to four of 13 afte r 1981. In the long term, patients treated with an extra-anatomic reco nstruction had a poorer prognosis than those treated by in situ recons truction. This experience shows that diagnostic tests often fail to re veal a prosthesis-related fistula and that mortality can be substantia lly reduced by early exploration in patients with negative diagnostic studies.