Aorto-Enteric Fistula After Aortic Reconstruction: Comparison Of Endovascular, Transperitoneal And Retroperitoneal Approaches

Purpose: One of the most feared complications of aortic reconstruction is aorto-enteric fistula (AEF). In this study, we analyze our experience with AEF in transabdominal, retroperitoneal and endovascular AAA repair
Methods: During the past 25 years, 4270 aortic reconstructions for aneurysm were performed; 1001 endografts, 247 transperitoneal and 3032 via retroperitoneal approach. Risk factors were similar in all three groups except for increased cardiovascular risk in patients undergoing endovascular AAA repair. Data was collected prospectively in our vascular registry. Perioperative morbidity, mortality and long term complications were recorded. Of specific note were patients who returned for follow-up with AEF or erosions.
Results: Perioperative mortality for ruptured and elective AAA repair was 18/1001 (1.8%) for endovascular reconstructions, 24/247 (9.72%) for transperitoneal, and 189/3032 (6.23%) for retroperitoneal. There was one AEF in the endovascular (.1%), 3 (1.2%) in the transperitoneal, and 2 (0.07%) in the retroperitoneal group. The patient in the endovascular group had his graft removed and died in the perioperative period, 3 patients in the transperitoneal group had their graft removed at 3 months, 16 months and 18 months. All are alive with follow-up of 19-170 months. Of the two patients in the retroperitoneal group, one died after repair of his AEF and the other had an axillobifemoral bypass and is still alive at 13 months.
Conclusion: AEF remains a difficult problem but the incidence is low and in our experience it is lowest in endovascular and retroperitoneal reconstruction of AAA and significantly higher in patients undergoing transabdominal reconstructions.