Fact-sheet: Aortoenteric fistula


Updated on 10/03/2018 at 2:54 PM

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Definition

Infection of a synthetic vascular graft with aorto-(or graft-)enteric fistula is the most serious complication.

Its severity is related to:

  • life-threatening consequences (50% mortality)
  • functional consequences (30% amputation rate)
  • the underlying infection, itself correlated with involvement of the graft body and the anastomoses.

Clinical features

Aortoenteric fistula is the first diagnosis to consider in a patient with an aortic graft presenting with hematochezia or melena, even if minimal!

Highly variable clinical presentation:

  • acute or chronic gastrointestinal bleeding
  • prolonged fever
  • abdominal pain

Ultrasound

Ultrasound may show pseudoaneurysms or a periprosthetic collection, but the absence of a collection does not rule out infection.

CT

CT is the most sensitive modality (ahead of endoscopy); criteria for graft infection include:

  • gas foci within the periprosthetic collection
  • thickening and retraction of the adjacent bowel wall
  • presence of a pseudoaneurysm
  • periprosthetic fluid collection
  • contrast extravasation into the bowel lumen is almost never seen, and its absence should not call into question the diagnosis of aortoenteric fistula!

Management

Long-term antibiotic therapy and surgical treatment