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A Journal on Surgery

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Minerva Chirurgica 2006 October;61(5):445-50

language: English

Recurrence of postoperative aortic fistulas: is there an ideal method of prevention? A case report

Picichè M. 1, Demaria R. G. 1, Miguel B. 2, Frapier J. M. 1, Rouviere P. 1, Battistella P. 1, Albat B. 1

1 Department of Cardiovascular Surgery Arnaud de Villeneuve Hospital Montpellier Teaching Hospital Montpellier University, Montpellier, France
2 Department of Cardiovascular Surgery Gabriel Montpied Hospital Clermont-Ferrand Teaching Hospital Clermont-Ferrand University,
Clermont-Ferrant, France


There are very few cases in English literature of recurrent postoperative aortic fistulas (RPAFs). These are neocommunications between the aortic bloodstream and the lumen of contiguous organs which occur after unpredictable periods from surgical treatment of a previous fistula. The supradiaphragmatic aorta may fistulizate into the airways, pulmonary circulation, oesophagus, and cardiac chambers; the infradiaphragmatic aorta into the intestine, stomach, and vena cava. According to the etiology, aortic fistulas are categorized as postoperative (or secondary) and spontaneous (or primary), and RPAF may be considered a subgroup of secondary fistulas. They may recur even more times in the same patient, hence the role of prevention is of the utmost importance. The simultaneous respect of different surgical principles is crucial to make the risk of recurrence less likely. Surgical treatment represents a real challenge due to the emergency conditions and redo nature of operations. Mortality rate is very high. In this article, we describe a case of recurrent aorto-duodenal communication, we discuss the principles of prevention both for the supra and infradiaphragmatic aorta, we introduce some modifications to the classic categorization and we present the first RPAF literature review.

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