Surgical treatment of abdominal infective native aortic aneurysm combined with aortodigestive fistula

ZHENG Yue-hong; LI Si-ting

doi:10.19538/j.cjps.issn1005-2208.2024.12.11

Abstract：Infective native aortic aneurysm(INAA)is a condition characterized by the destruction and dilation of the aortic wall caused by pathogenic microorganism infection,which may lead to primary aorto-enteric fistula and life-threatening gastrointestinal hemorrhage,requiring urgent surgical intervention.Surgical treatment options for INAA include open surgical repair(OSR)and endovascular aneurysm repair(EVAR).OSR,which involves debridement of infected tissue and revascularization,is considered the gold standard but is associated with significant surgical trauma.In contrast,EVAR is less invasive but may not completely eradicate the infection.The treatment of INAA with concurrent aorto-enteric fistula requires an individualized approach based on the patient's infection status,extent of the lesion,and microbial characteristics.OSR techniques include extra-anatomic bypass and in situ reconstruction.Extra-anatomic bypass allows complete removal of the infected lesion,while in situ reconstruction offers physiological and anatomical advantages but may leave residual infection.In recent years,the emergent use of EVAR in hemodynamically unstable patients has been shown to stabilize their condition and facilitate subsequent open surgery.The success of treatment relies heavily on effective perioperative and long-term antibiotic therapy to reduce the risk of infection recurrence.Although various treatment strategies have been reported as successful in case studies,high-quality clinical evidence on the optimal treatment approach remains limited.The management of INAA requires careful consideration of the patient's pathological characteristics and clinical condition to provide the best clinical approach for treating infectious abdominal aortic aneurysm with concurrent aorto-enteric fistula.