Abdominal aortic aneurysms complicated by spontaneous iliocaval or duodenal fistulae
Hickey, N.C.; Downing, R.; Hamer, J.D.; Ashton, F.; Slaney, G.
Journal of Cardiovascular Surgery 32(2): 181-185
1991
ISSN/ISBN: 0021-9509 PMID: 2019618 Document Number: 377246
Seven hundred and twenty one abdominal aortic aneurysms were treated between 1960 and 1985. Twenty one of these (2.9%) were complicated by the development of a spontaneous primary fistula, 16 (2.2%) into the vena cava or iliac veins and 5 (0.7%) into the duodenum. A correct preoperative diagnosis was made in only four instances, two aorto-caval and two aorto-duodenal fistulae. Hospital mortality was 44% for aorto-caval and 60% for aorto-duodenal fistulae. Despite the lack of a precise preoperative diagnosis in the majority of cases, the prognosis for aorto-caval fistula remained comparable to that for patients undergoing emergency surgery for uncomplicated ruptured aortic aneurysms. The mortality of spontaneous aorto-duodenal fistuale was appreciably higher and the aneurysmal contents of 4 out of these 5 cases had positive bacterial cultures.