IN electing surgery for abdominal aortic aneurysms, one contrasts the natural history of a particular aneurysm with the natural history of the patient's general diseases plus the surgical mortality. A large factor in the initial surgical mortality is the patient's associated illnesses, especially coronary atherosclerosis, while the late nonsurgical mortality is largely due to the progression of the other diseases, again most commonly coronary atherosclerosis.
In this and many series of aortic aneurysmectomies, the late surgical mortality approaches the initial mortality in significance, and it is to this problem that this study is addressed. Late surgical mortality is due to graft failure from sepsis or false aneurysm. The infected grafts usually present with early bleeding and/or sepsis. The false aneurysms can be delayed for months or years and usually present as enteric fistulas.
In reviewing a personal series of 119 patients with surgically treated abdominal aortic aneurysms, seven aorto-enteric fistulas