Aortoenteric fistulas

Abstract

A 63-year-old smoking woman presented with severe intermittent claudication for a couple of years. Her walking distance had gradually decreased to around 50-100 m. She had previously been healthy and very active. At investigation, she had no femoral pulses and a bilateral ankle brachial index of 0.6. Further evaluation with angiography showed an aortic occlusion at the level of the renal arteries, and she was reconstructed with an aorto-bi-iliac polyester graft (16 × 8 mm) after local proximal aortic endarterectomy. The proximal anastomosis was made end to end, and the iliac end to side. Polypropylene sutures were used. The operation was somewhat technically difficult, with the proximal anastomosis having to be redone; the duration of surgery was 3.5 h with a blood loss of around 800 mL. The immediate postoperative course was uneventful. After 3 years, the patient had distal septic microembolization in the left leg with an abscess around the left distal graft limb. This was extirpated, the wound was drained and a femoral-femoral cross-over graft was inserted. She was put on antibiotics for 6 months. Five years after the aortic operation, she had melaena and a decrease in hemoglobin.