In-situ revascularisation for secondary aorto-enteric fistulae: the success of silver-coated Dacron is closely linked to a suitable bowel repair

Eur J Vasc Endovasc Surg. 2012 Oct;44(4):417-24. doi: 10.1016/j.ejvs.2012.04.004.

Abstract

Objectives: The purpose of this study was to assess short- and mid-term results of in-situ revascularisation (ISR) using silver-coated Dacron prostheses and bowel repair for management of secondary aorto-enteric fistulae (SAEF).

Design: Single-centre retrospective chart review.

Material and methods: This study includes all the patients treated by ISR using silver-coated Dacron for SAEF between 2006 and 2010. Primary end points were mortality and survival rates. Secondary end points were reinfection-free survival and secondary patency rates.

Results: Eighteen male patients with SAEF with a median age of 64 years were operated by ISR using silver-coated Dacron during the study period without operative death. The 30-day mortality was 22% and the in-hospital mortality rate was 39%. Indeed, during hospitalisation, a duodenal leak was observed in four patients including three who died. Four others patients died due to multi-system organ failure. Median follow-up was 16 months (range 1-66). The survival rate at 12 months was 55%. One duodenal leak was observed leading to death. The reinfection-free survival and the secondary patency rates at 12 months were 60% and 89%, respectively.

Conclusion: In-situ revascularisation with silver-coated Dacron provides acceptable results in terms of mortality. This treatment may be useful for simple vascular reconstruction and allow greater attention to bowel repair that is a determinant in short- and mid-term survival.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Anastomosis, Surgical
  • Aorta, Abdominal / surgery
  • Aortic Diseases / complications
  • Aortic Diseases / diagnostic imaging
  • Aortic Diseases / surgery*
  • Blood Vessel Prosthesis
  • Coated Materials, Biocompatible*
  • Duodenal Diseases / complications
  • Duodenal Diseases / diagnostic imaging
  • Duodenal Diseases / surgery*
  • Duodenum / surgery
  • Follow-Up Studies
  • Humans
  • Intestinal Fistula / complications
  • Intestinal Fistula / diagnostic imaging
  • Intestinal Fistula / surgery*
  • Ischemia / diagnostic imaging
  • Ischemia / etiology
  • Ischemia / surgery*
  • Leg / blood supply*
  • Male
  • Middle Aged
  • Polyethylene Terephthalates
  • Prosthesis Design
  • Retrospective Studies
  • Silver
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Vascular Fistula / complications
  • Vascular Fistula / diagnostic imaging
  • Vascular Fistula / surgery*

Substances

  • Coated Materials, Biocompatible
  • Polyethylene Terephthalates
  • Silver