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Complications of Abdominal Aortic Surgery: Part I: Aortoenteric Fistula

Complications of Abdominal Aortic Surgery: Part I: Aortoenteric Fistula Abstract A careful review of the English-language literature has disclosed 44 cases of aortoenteric fistula after aortic surgery, reported in 26 articles. We know of 26 additional instances of this condition. Twenty-two of these have occurred within our own experience, and in 11 repair was attempted. A review of these 70 cases brings to light certain correlations from which tentative conclusions regarding etiology and prevention may be drawn. Incidence We have seen 20 cases of aortoenteric fistula in which we had done the original operation. We have also seen 24 instances of hemorrhage from an arterioplasty into the retroperitoneal space without involvement of the intestine. These 44 ruptures have occurred in a total of 850 abdominal aortic operations—an incidence of 5%. Of these 44, ten aortoenteric fistulae and 16 retroperitoneal hemorrhages were reoperated on in our hospital. Information concerning the remaining 18 cases was derived from a vigorous followup program. There References 1. Barnes, W. H.; Ellis, F. H., Jr; Kirklin, J. W., and Edwards, J. E.: Experiences with 165 Aortic Homografts , Surg. Gynec. Obstet. 106:49-55 ( (Jan.) ) 1958. 2. Boyd, D. P., and Pastel, H.: Results of Treatment of Aneurysm of Abdominal Aorta , Postgrad. Med. 25:238-242 ( (March) ) 1959. 3. Brock, R. C.: Aortic Homografting , Guy. Hosp. Rep. 102:204-228, 1953. 4. Brown, L., and Essig, H.: Fatal Rupture of Ivalon (Polyvinal Formalinized) Sponge Aortic Graft into Duodenum: A Case Report , A.M.A. Arch. Surg. 79:72-74, 1959.Crossref 5. Case Records of Massachusetts General Hospital (Case 45282) , New Engl. J. Med. 261:92-96 ( (July 9) ) 1959.Crossref 6. Case Records of Massachusetts General Hospital (Case 45522) , New Engl. J. Med. 261:1339-1342 ( (Dec. 24) ) 1959.Crossref 7. Claytor, H.; Birch, L.; Cardwell, E. S., and Zimmerman, S. L.: Suture-Line Rupture of Nylon Aortic Bifurcation Graft into Small Bowel , A.M.A. Arch. Surg. 73:947-950 ( (Dec.) ) 1956.Crossref 8. Javid, H.; Dye, W. S.; Grove, W. J., and Julian, O. C.: Resection of Ruptured Aneurysms of Abdominal Aorta , Ann. Surg. 142:613-623 ( (Oct.) ) 1955.Crossref 9. Cordell, A. R.; Wright, R. H., and Johnston, F. R.: Gastrointestinal Hemorrhage After Abdominal Aortic Operations , Surgery 48:997-1005 ( (Dec.) ) 1960. 10. Crawford, E. S.; DeBakey, M. E.; Morris, G. C., Jr., and Garrett, E.: Evaluation of Late Failures After Reconstructive Operations for Occlusive Lesions of Aorta and Iliac Femoral, and Popliteal Arteries , Surgery 47:79-104 ( (Jan.) ) 1960. 11. Creech, O., Jr.; Deterling, R. A., Jr.; Edwards, S.; Julian, O. C.; Linton R. R., and Shumacher, H., Jr.: Vascular Prostheses: Report of the Committee for the Study of Vascular Prostheses of the Society for Vascular Surgery , Surgery 41:62-80 ( (Jan.) ) 1957. 12. DeWeese, J. A.; Woods, W. D., and Dale, W. A.: Failures of Homografts as Arterial Replacements , Surgery 46:565-578 ( (Sept.) ) 1959. 13. DeWeese, M. S., and Fry, W. J.: Small Bowel Erosion Following Aortic Resection , J.A.M.A. 179:882-886 ( (March 17) ) 1962.Crossref 14. Elliot, J. A.; McKenzie, A. D., and Chung, W. B.: Ruptured Abdominal Aortic Aneurysm , Surgery 46:605-617 ( (Sept.) ) 1959. 15. Erskine, J. M.; Thoshinsky, M., and Wilson, J. L.: Rupture of Aortic Homografts into Small Intestine: Report of 2 Cases Successfully Treated by Resection of Perforated Homograft and Regrafting of Defect , Ann. Surg. 152:991-997 ( (Dec.) ) 1960.Crossref 16. Etheredge, S.: Unpublished report, quoted by Erskine, J. M., et al.15 17. Groves, L. K.: Personal communication to the author. 18. Hagland, L. A.; Sweetman, W. R., and Wise, R. A.: Rupture of Abdominal Aortic Homograft with Ileal Fistula , Amer. J. Surg. 98:746-749 ( (Nov.) ) 1959.Crossref 19. Halpert, B.; DeBakey, M. E.; Jordan, G. L., Jr., and Henley, W. S.: Fate of Homografts and Prostheses of Human Aorta , Surg. Gynec. Obstet. 111:659-674 ( (Dec.) ) 1960. 20. Hershey, C.: Personal communication to the author. 21. Humphries, A. W.; deWolfe, V. G., and LeFevre, F. A.: Analysis of 120 Consecutive Cases of Major Arterial Grafts , J.A.M.A. 161:953-956 ( (July 7) ) 1956.Crossref 22. Humphries, A. W.; Hawk, W. A.; deWolfe, V. G., and LeFevre, F. A.: Clinicopathologic Observations on the Fate of Arterial Freeze-Dried Homografts , Surgery 45:59-71 ( (Jan.) ) 1959. 23. Lawton, R. L.; Peterson, F. R., and Brintnall, E. S.: Aorto-Intestinal Fistula Following Aortic Homotransplantation , Angiology 10:85-89 ( (April) ) 1959.Crossref 24. MacKenzie, R. J.; Buell, A. H., and Pearson, S. C.: Aneurysm of Aortic Homograft with Rupture into Duodenum , A.M.A. Arch. Surg. 77: 965-969 ( (Dec.) ) 1958.Crossref 25. MacVaugh, H., III, and Roberts, B.: Results of Resection of Abdominal Aortic Aneurysm , Surg. Gynec. Obstet. 113:17-23 ( (July) ) 1961. 26. Nevin, I. N.; Bump, W. S., and Thuerer, G. R.: Preoperative Diagnosis of Rupture into Duodenum of Aortic Homograft Anastomosis , New Engl. J. Med. 263:243-245 ( (Aug. 4) ) 1960.Crossref 27. Ohara, I., and Nakano, S.: Rupture of Arterial Plastic Prosthesis (Amylan-Polyethylene Tube) , A.M.A. Arch. Surg. 77:55-59 ( (July) ) 1958.Crossref 28. Pollock, A. V.; Pratt, D., and Smiddy, F. G.: Aortic Homograft Replacement: A Sequel , Ann. Surg. 153:472-476 ( (March) ) 1961.Crossref 29. Sharf, A. G., and Acker, E. D.: Surgical Intervention in Ruptured and Thrombosed Aortic Homografts: Subsequent Late and Fatal Complications , A.M.A. Arch. Surg. 78:67-70 ( (Jan.) ) 1959.Crossref 30. Sheranian, L. O.; Edwards, J. E., and Kirklin, J. W.: Late Results in 110 Patients with Abdominal Aortic Aneurysm Treated by Resectional Placement of Aortic Homograft , Surg. Gynec. Obstet. 109: 309-314 ( (Sept.) ) 1959. 31. Szilagyi, E.: Personal communication to the author. 32. Thistlethwaite, J. R.; Hughes, R. K.; Smyth, N. P., and Cornwell, E. E., Jr.: Spontaneous Arteriovenous Fistula Between Abdominal Aorta and Vena Cava , Arch. Surg. 81:61-64 ( (July) ) 1960.Crossref 33. Tolstedt, G. E., and Bell, J. W.: Aorticoduodenal Fistula After Aortic Homograft Without Aneurysm Formation , New Engl. J. Med. 264:816-817 ( (April 20) ) 1961.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Complications of Abdominal Aortic Surgery: Part I: Aortoenteric Fistula

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Publisher
American Medical Association
Copyright
Copyright © 1963 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1963.01310070045006
Publisher site
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Abstract

Abstract A careful review of the English-language literature has disclosed 44 cases of aortoenteric fistula after aortic surgery, reported in 26 articles. We know of 26 additional instances of this condition. Twenty-two of these have occurred within our own experience, and in 11 repair was attempted. A review of these 70 cases brings to light certain correlations from which tentative conclusions regarding etiology and prevention may be drawn. Incidence We have seen 20 cases of aortoenteric fistula in which we had done the original operation. We have also seen 24 instances of hemorrhage from an arterioplasty into the retroperitoneal space without involvement of the intestine. These 44 ruptures have occurred in a total of 850 abdominal aortic operations—an incidence of 5%. Of these 44, ten aortoenteric fistulae and 16 retroperitoneal hemorrhages were reoperated on in our hospital. Information concerning the remaining 18 cases was derived from a vigorous followup program. There References 1. Barnes, W. H.; Ellis, F. H., Jr; Kirklin, J. W., and Edwards, J. E.: Experiences with 165 Aortic Homografts , Surg. Gynec. Obstet. 106:49-55 ( (Jan.) ) 1958. 2. Boyd, D. P., and Pastel, H.: Results of Treatment of Aneurysm of Abdominal Aorta , Postgrad. Med. 25:238-242 ( (March) ) 1959. 3. Brock, R. C.: Aortic Homografting , Guy. Hosp. Rep. 102:204-228, 1953. 4. Brown, L., and Essig, H.: Fatal Rupture of Ivalon (Polyvinal Formalinized) Sponge Aortic Graft into Duodenum: A Case Report , A.M.A. Arch. Surg. 79:72-74, 1959.Crossref 5. Case Records of Massachusetts General Hospital (Case 45282) , New Engl. J. Med. 261:92-96 ( (July 9) ) 1959.Crossref 6. Case Records of Massachusetts General Hospital (Case 45522) , New Engl. J. Med. 261:1339-1342 ( (Dec. 24) ) 1959.Crossref 7. Claytor, H.; Birch, L.; Cardwell, E. S., and Zimmerman, S. L.: Suture-Line Rupture of Nylon Aortic Bifurcation Graft into Small Bowel , A.M.A. Arch. Surg. 73:947-950 ( (Dec.) ) 1956.Crossref 8. Javid, H.; Dye, W. S.; Grove, W. J., and Julian, O. C.: Resection of Ruptured Aneurysms of Abdominal Aorta , Ann. Surg. 142:613-623 ( (Oct.) ) 1955.Crossref 9. Cordell, A. R.; Wright, R. H., and Johnston, F. R.: Gastrointestinal Hemorrhage After Abdominal Aortic Operations , Surgery 48:997-1005 ( (Dec.) ) 1960. 10. Crawford, E. S.; DeBakey, M. E.; Morris, G. C., Jr., and Garrett, E.: Evaluation of Late Failures After Reconstructive Operations for Occlusive Lesions of Aorta and Iliac Femoral, and Popliteal Arteries , Surgery 47:79-104 ( (Jan.) ) 1960. 11. Creech, O., Jr.; Deterling, R. A., Jr.; Edwards, S.; Julian, O. C.; Linton R. R., and Shumacher, H., Jr.: Vascular Prostheses: Report of the Committee for the Study of Vascular Prostheses of the Society for Vascular Surgery , Surgery 41:62-80 ( (Jan.) ) 1957. 12. DeWeese, J. A.; Woods, W. D., and Dale, W. A.: Failures of Homografts as Arterial Replacements , Surgery 46:565-578 ( (Sept.) ) 1959. 13. DeWeese, M. S., and Fry, W. J.: Small Bowel Erosion Following Aortic Resection , J.A.M.A. 179:882-886 ( (March 17) ) 1962.Crossref 14. Elliot, J. A.; McKenzie, A. D., and Chung, W. B.: Ruptured Abdominal Aortic Aneurysm , Surgery 46:605-617 ( (Sept.) ) 1959. 15. Erskine, J. M.; Thoshinsky, M., and Wilson, J. L.: Rupture of Aortic Homografts into Small Intestine: Report of 2 Cases Successfully Treated by Resection of Perforated Homograft and Regrafting of Defect , Ann. Surg. 152:991-997 ( (Dec.) ) 1960.Crossref 16. Etheredge, S.: Unpublished report, quoted by Erskine, J. M., et al.15 17. Groves, L. K.: Personal communication to the author. 18. Hagland, L. A.; Sweetman, W. R., and Wise, R. A.: Rupture of Abdominal Aortic Homograft with Ileal Fistula , Amer. J. Surg. 98:746-749 ( (Nov.) ) 1959.Crossref 19. Halpert, B.; DeBakey, M. E.; Jordan, G. L., Jr., and Henley, W. S.: Fate of Homografts and Prostheses of Human Aorta , Surg. Gynec. Obstet. 111:659-674 ( (Dec.) ) 1960. 20. Hershey, C.: Personal communication to the author. 21. Humphries, A. W.; deWolfe, V. G., and LeFevre, F. A.: Analysis of 120 Consecutive Cases of Major Arterial Grafts , J.A.M.A. 161:953-956 ( (July 7) ) 1956.Crossref 22. Humphries, A. W.; Hawk, W. A.; deWolfe, V. G., and LeFevre, F. A.: Clinicopathologic Observations on the Fate of Arterial Freeze-Dried Homografts , Surgery 45:59-71 ( (Jan.) ) 1959. 23. Lawton, R. L.; Peterson, F. R., and Brintnall, E. S.: Aorto-Intestinal Fistula Following Aortic Homotransplantation , Angiology 10:85-89 ( (April) ) 1959.Crossref 24. MacKenzie, R. J.; Buell, A. H., and Pearson, S. C.: Aneurysm of Aortic Homograft with Rupture into Duodenum , A.M.A. Arch. Surg. 77: 965-969 ( (Dec.) ) 1958.Crossref 25. MacVaugh, H., III, and Roberts, B.: Results of Resection of Abdominal Aortic Aneurysm , Surg. Gynec. Obstet. 113:17-23 ( (July) ) 1961. 26. Nevin, I. N.; Bump, W. S., and Thuerer, G. R.: Preoperative Diagnosis of Rupture into Duodenum of Aortic Homograft Anastomosis , New Engl. J. Med. 263:243-245 ( (Aug. 4) ) 1960.Crossref 27. Ohara, I., and Nakano, S.: Rupture of Arterial Plastic Prosthesis (Amylan-Polyethylene Tube) , A.M.A. Arch. Surg. 77:55-59 ( (July) ) 1958.Crossref 28. Pollock, A. V.; Pratt, D., and Smiddy, F. G.: Aortic Homograft Replacement: A Sequel , Ann. Surg. 153:472-476 ( (March) ) 1961.Crossref 29. Sharf, A. G., and Acker, E. D.: Surgical Intervention in Ruptured and Thrombosed Aortic Homografts: Subsequent Late and Fatal Complications , A.M.A. Arch. Surg. 78:67-70 ( (Jan.) ) 1959.Crossref 30. Sheranian, L. O.; Edwards, J. E., and Kirklin, J. W.: Late Results in 110 Patients with Abdominal Aortic Aneurysm Treated by Resectional Placement of Aortic Homograft , Surg. Gynec. Obstet. 109: 309-314 ( (Sept.) ) 1959. 31. Szilagyi, E.: Personal communication to the author. 32. Thistlethwaite, J. R.; Hughes, R. K.; Smyth, N. P., and Cornwell, E. E., Jr.: Spontaneous Arteriovenous Fistula Between Abdominal Aorta and Vena Cava , Arch. Surg. 81:61-64 ( (July) ) 1960.Crossref 33. Tolstedt, G. E., and Bell, J. W.: Aorticoduodenal Fistula After Aortic Homograft Without Aneurysm Formation , New Engl. J. Med. 264:816-817 ( (April 20) ) 1961.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jan 1, 1963

References

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