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Contemporary Management of Secondary Aortoduodenal Fistula.

Publication ,  Conference
Howard, R; Kurz, S; Sherman, MA; Underhill, J; Eliason, JL; Coleman, DM
Published in: Ann Vasc Surg
November 2015

BACKGROUND: Secondary aortoduodenal fistula (SADF) is a rare, life-threatening complication of abdominal aortic reconstruction. Clinical presentation varies and treatment requires complex surgical repair associated with considerable morbidity and mortality. This retrospective study examines the contemporary management of SADF at a tertiary vascular surgical practice. METHODS: Thirteen patients were managed for SADF between 2004 and 2014. Vascular and duodenal reconstructions were considered. Primary end points included bile leak, major complications, and mortality. RESULTS: Of the 13 patients presenting with SADF, 6 presented with luminal blood loss. During mean follow-up (632 days), the rate of major complication was 77%. Overall, 38% developed duodenal leak. All leaks occurred after graft explantation with extra-anatomic bypass, and the majority of these patients (80%) had no preceding history of acute gastrointestinal (GI) bleed. There were no leaks identified after duodenal exclusion with gastrojejunostomy. Patients that developed duodenal leak had longer mean intensive care unit length of stay (LOS; 7.0 vs. 2.3 days, P = 0.004), longer mean overall hospital LOS (36.6 vs. 18.5 days, P = 0.012), and greater late mortality (40% vs. 13%). There were 2 SADF-related deaths. Overall mortality trended higher in females (67% vs. 20%, P = 0.125) and those that presented without acute GI bleed (43% vs. 17%, P = 0.308). CONCLUSIONS: Surgical reconstruction for SADF results in major morbidity. Those presenting with acute GI bleed trended toward better outcomes than those without. Duodenal leak remains a serious complication. Duodenal exclusion may represent a more appropriate and conservative approach for management of the duodenal defect in select patients.

Duke Scholars

Published In

Ann Vasc Surg

DOI

EISSN

1615-5947

Publication Date

November 2015

Volume

29

Issue

8

Start / End Page

1614 / 1618

Location

Netherlands

Related Subject Headings

  • Vascular Fistula
  • Treatment Outcome
  • Retrospective Studies
  • Middle Aged
  • Male
  • Intestinal Fistula
  • Humans
  • Gastric Bypass
  • Female
  • Duodenal Diseases
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Howard, R., Kurz, S., Sherman, M. A., Underhill, J., Eliason, J. L., & Coleman, D. M. (2015). Contemporary Management of Secondary Aortoduodenal Fistula. In Ann Vasc Surg (Vol. 29, pp. 1614–1618). Netherlands. https://doi.org/10.1016/j.avsg.2015.06.090
Howard, Ryan, Sarah Kurz, Matthew A. Sherman, Joshua Underhill, Jonathan L. Eliason, and Dawn M. Coleman. “Contemporary Management of Secondary Aortoduodenal Fistula.” In Ann Vasc Surg, 29:1614–18, 2015. https://doi.org/10.1016/j.avsg.2015.06.090.
Howard R, Kurz S, Sherman MA, Underhill J, Eliason JL, Coleman DM. Contemporary Management of Secondary Aortoduodenal Fistula. In: Ann Vasc Surg. 2015. p. 1614–8.
Howard, Ryan, et al. “Contemporary Management of Secondary Aortoduodenal Fistula.Ann Vasc Surg, vol. 29, no. 8, 2015, pp. 1614–18. Pubmed, doi:10.1016/j.avsg.2015.06.090.
Howard R, Kurz S, Sherman MA, Underhill J, Eliason JL, Coleman DM. Contemporary Management of Secondary Aortoduodenal Fistula. Ann Vasc Surg. 2015. p. 1614–1618.
Journal cover image

Published In

Ann Vasc Surg

DOI

EISSN

1615-5947

Publication Date

November 2015

Volume

29

Issue

8

Start / End Page

1614 / 1618

Location

Netherlands

Related Subject Headings

  • Vascular Fistula
  • Treatment Outcome
  • Retrospective Studies
  • Middle Aged
  • Male
  • Intestinal Fistula
  • Humans
  • Gastric Bypass
  • Female
  • Duodenal Diseases