To the Editor.—The protection of the duodenum from the development of an aortoenteric fistula following aneurysm resection and graft replacement has been a concern of surgeons since the initiation of the procedure. NumerCreation of barrier against fistula using remaining aneurysm wall. ous techniques1-5 have been proposed to prevent this complication. With the development of the inclusion technique,6 a large amount of aneurysm wall remains, permitting construction of a barrier of thickened aneurysmal wall between the proximal anastomotic line and the overlying duodenum.
Following the insertion of the graft to replace the aneurysm, a flap of aneurysm wall is fashioned from either side of the remaining aortic wall (Figure). This is swung anteriorly over the proximal anastomotic line and sutured to tissue overlying the proximal portion of the aorta with interrupted 3-0 polyglycolic acid sutures, with care being taken to avoid entering the vessel. The remainder of the