Secondary aortoenteric fistulae - Changes from 1973 to 1993

Aim: To investigate a series of patients with secondary aortoenteric fistulas and compare it with a previous series (1985-93 vs. 1973-84). Design: Retrospective study of medical records. Setting Sixteen vascular surgical centres in Sweden. Patients: Twenty-seven patients were identified making an overall incidence of 0.5% of all aortoiliac operations. Among aneurysm patients the incidence was significantly lower than in the previous series. One patient record could not be identified. Fourteen primary operations were for aortic aneurysm, 22 for occlusive disease and one was an aortorenal vein bypass. Results: Symptoms of the fistula occurred after a median interval of 90 months which is significantly later than the previous series (32 months; p < 0.05). The commonest presentation was bleeding followed by septis. The median diagnostic delay was 10.5 days, which was significantly shorter than in the previous series. Most fistulas involved the duodenum (88%). One patient died before surgery. The postoperative mortality was 28%, significantly lower than in the previous series (58%) (p < 0.05). At the end of follow up (median 43 months) significantly more patients were alive than in the previous series (42% vs. 18%) (p < 0.05). Conclusion: Over a 21 year period there seems to have been a decrease in the frequency of secondary aortoenteric fistulas after aneurysm surgery a longer interval before they occur a shorter diagnostic delay, and a better survival.