[Our experience in the emergency treatment of secondary aortoenteric fistulae. The preliminary results of the use of aortic homografts].

The digestive prosthetic aortic fistulas are connections between an aortic prosthesis and the duodenum. From January 1988 to January 1994, in the vascular surgery section of Busto Arsizio hospital, 12 patients received emergency treatment for digestive aortic fistulas, with a prosthesis being positioned extra-anatomically. A different treatment was used for three patients who were treated during the period from January 1994 to July 1994. For the second group the old prosthesis was replaced by a homograft. On the first group of 12 patients, 5 had previously been operated on for obstructive arteriopathy of the legs; the other 7 had previously been operated on for an abdominal aortic aneurysm. In 50% of these 12 cases the prosthesis used was a bifemoral aortic prosthesis, in 30% bisiliac aortic, and in 20% an aorto aortic prosthesis. There was an interval, from one month to 20 years depending on the patient, between the first and the second operations. The average age of the patients was 61.2 years. Six of the patients were extreme emergency cases and were operated on immediately on their arrival at the hospital, while the other 6 were operated on 2-3 days after their arrival. Five patients died whilst they were being operated on (3 from haemorrhagic shock, 2 from sepsis and multi-organ failure). None of the patients who were treated from January 1994 to July 1994 died during their operations. The homograft was removed from a multi-organ donor. In treatment such as this, the most important thing is to remove the old prosthesis. The following is a discussion of the techniques used to clamp the aorta and to provide alternative limb vascularization.