Aorto-enteric fistula: changing management strategies.

BACKGROUND

Traditionally treatment of aorto-enteric fistulae involved placement of an extra-anatomic bypass and graft excision. This is associated with limb loss (10-40%) and high mortality (10-70%). More recently in situ revascularisation has been advocated.

AIMS

To examine our experience with the changing management of aorto-enteric fistulae over a 22-year period.

METHODS

Demographic, clinical, operative and pathological data were recorded retrospectively.

RESULTS

Twenty-one patients were included. Seven had primary fistulae. Six died prior to intervention. Five had an extra-anatomical bypass (60% mortality, 40% limb loss), four had in-situ revascularisation (25% mortality), four had a primary repair (25% mortality) and two had insertion of a tube graft (primary fistulae). The overall survival rate was 38%. The postoperative survival rate was 6o%.

CONCLUSION

Techniques for operative management continue to evolve. The current trend is towards a local surgical approach with prolonged and intensive postoperative antimicrobial therapy. In our experience this approach has yielded acceptable outcomes.