Gnus Jan, Ferenc Stanisław, Kościelna Magdalena, Paprocka-Borowicz Małgorzata, Dawidczyk Piotr, Dziewiszek Małgorzata, Witkiewicz Wojciech
Department of General and Vascular Surgery, Voivodship Specialist Hospital in Wrocław, Poland.
Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Wroclaw Medical University, Poland.
Adv Clin Exp Med. 2016 Nov-Dec;25(6):1265-1271. doi: 10.17219/acem/66621.
Secondary aortoenteric fistula is a rare but severe complication occurring after abdominal aortic graft implementation.
The aim of our study was to review the clinical presentation, diagnosis and postoperative course of patients with aortoenteric fistulas following vascular operations on the abdominal aorta in the years 2000-2014.
Among all the patients treated in our center, during a 10-year period, aortoenteric fistulas were observed in 24 cases. The first symptoms occurred between 4 weeks and 8 years after the procedure (3.4 years on average). The most common clinical presentation was gastrointestinal bleeding in 16 cases (66.7%). All patients underwent surgical repair of an aortoenteric fistula, with graft removal and replacement in situ using silver impregnated prosthesis.
The 30-day mortality rate after surgical treatment of SAEF was 37.5% (9 patients). Causes of death included: hemorrhagic shock, multi-organ failure and myocardial infarction. The early complications after the surgical repair of an aortoenteric fistula occurred in 19 (79.2%) patients. Mortality during the one-year follow-up period was 38.5% (5 patients) and the one-year complication rate was 69.2%.
Each patient with a history of abdominal aortic graft implementation and presenting symptoms of gastrointestinal bleeding requires careful diagnosing for aortoenteric fistula. New methods of surgical treatment offering lower mortality should be developed.
继发性主动脉肠瘘是腹主动脉移植术后发生的一种罕见但严重的并发症。
我们研究的目的是回顾2000年至2014年期间接受腹主动脉血管手术后发生主动脉肠瘘患者的临床表现、诊断及术后病程。
在我们中心接受治疗的所有患者中，在10年期间观察到24例主动脉肠瘘。首次症状出现在手术后4周至8年之间（平均3.4年）。最常见的临床表现是16例（66.7%）出现胃肠道出血。所有患者均接受了主动脉肠瘘的手术修复，移除移植物并使用含银假体原位置换。
SAEF手术治疗后的30天死亡率为37.5%（9例患者）。死亡原因包括：失血性休克、多器官功能衰竭和心肌梗死。主动脉肠瘘手术修复后的早期并发症发生在19例（79.2%）患者中。一年随访期内的死亡率为38.5%（5例患者），一年并发症发生率为69.2%。
每一位有腹主动脉移植病史且出现胃肠道出血症状的患者都需要仔细诊断是否患有主动脉肠瘘。应开发死亡率更低的新手术治疗方法。
