The use of synthetic vascular prosthesis in the surgical treatment of secondary aorto-duodenal fistulas.

In this paper the methods with synthetic vascular prosthesis used in surgical treatment of the secondary aorto-intestinal fistula are presented. 10 cases of 22 patients treated in the years 1993-2003 for secondary aorto-intestinal fistulas as a complication of vascular prosthesis infection are analysed. In all patients the abdominal CT, scintigraphy with technetium 99m labeled leucocytes and endoscopy were performed. The patients underwent the operation of infected dacron prosthesis' replacement with silver/collagen coated prosthesis or extraanatomic bypass (subclavian to femoral). To close the intestinal fistula the duodenectomy with gastroenterostomy was performed or the duodenum was sutured and protected with the use of pedicled omentum. In 4 patients extraanatomic subclavian-femoral of polytetrafluoroethylene (PTFE) bypass was used. In these cases the intestinal surgery was composed of the partial duodenectomy with fistula excision and duodenal stumps formation followed by antecolic gastrojejunostomy with the Braun's enteroanastomosis and pyloroplasty. In this group 2 patients (50%) died in the follow up period. There were two extraanatomic bypass thromboses in the 30 days follow up and one amputation (25%). The infected vascular prosthesis was replaced with silver/collagen coated prosthesis in the 6 patients. In these cases duodenal fistula was closed with two layers of stitches and additionally protected with pedicled fragment of the greater omentum, which was sewn on the duodenum. In this group 1 patients (16.7%) died in the follow up period. In one case (16.7%) in 9 months after operation reinfection od silver prosthesis was observed. There were no significative differences (p = 0.45) in terms of early mortality between both group of patients. The treatment of the fistula is a difficult and hazardous surgical procedure, results of which are unpredictable.