Lonn L, Dias N, Veith Schroeder T, Resch T
Department of Vascular Surgery Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
J Cardiovasc Surg (Torino). 2010 Jun;51(3):319-27.
Aortoenteric fistula formation is a devastating condition regardless of whether it is primary or secondary (i.e. after previous aneurysm repair) in nature. Patients present with signs and symptoms of gastrointestinal bleeding with or without signs of systemic infection and are often in a very poor clinical condition. Conventional treatment consists of extensive open surgery (extra-anatomical bypass or aortic ligation), closure of fistula tract and complete removal of any prosthetic material. This treatment is associated with high morbidity and mortality and therefore more minimally invasive options with endovascular repair have been attempted. Endovascular repair is often successful in the short-term achieving favorable immediate outcome. In the presence of systemic infection, however, EVAR alone as an ultimate solution is often followed by repeat infection and bleeding. A staged combination of EVAR treatment for acute bleeding and aggressive infection treatment with systemic and local antibiotics, surgical abscess revision and fistula tract closure might be an option in fragile patients. For patients fit for open repair, EVAR can be used as a bridging procedure to definitive repair particularly in the setting of systemic infection.
无论主动脉肠瘘是原发性还是继发性（即先前动脉瘤修复术后），其形成都是一种严重的病症。患者表现出胃肠道出血的体征和症状，伴有或不伴有全身感染迹象，且临床状况通常很差。传统治疗包括广泛的开放手术（解剖外旁路或主动脉结扎）、瘘管闭合以及完全移除任何假体材料。这种治疗与高发病率和死亡率相关，因此人们尝试了更多采用血管内修复的微创选择。血管内修复在短期内通常是成功的，能取得良好的即刻效果。然而，在存在全身感染的情况下，仅将血管内主动脉修复术（EVAR）作为最终解决方案，往往会导致反复感染和出血。对于身体虚弱的患者，分期联合采用血管内主动脉修复术治疗急性出血，并积极使用全身和局部抗生素进行抗感染治疗、手术修正脓肿以及闭合瘘管，可能是一种选择。对于适合开放修复的患者，血管内主动脉修复术可作为确定性修复的过渡性手术，尤其是在全身感染的情况下。
