总结继发性腹主动脉瘤肠瘘的诊治经验，提高治疗效果。

回顾性分析本院2000年1月至2014年12月接诊的6例腹主动脉瘤开放及腔内修复术后继发肠瘘患者的资料。2例初次手术方式为腹主动脉瘤切除+人工血管置换，4例为腹主动脉瘤腔内修复术。本次均以反复发热就诊，发热距初次手术中位时间11个月（1~27个月），2例伴有"预兆性消化道出血"。再次手术前确诊3例，其中2例放弃治疗。4例患者经充分准备后施行腋动脉-双侧股动脉人工血管旁路、移植物取出及肠修补，其中1例伴有主动脉膀胱瘘的患者同时行膀胱修补。

肠瘘位于十二指肠水平段2例，空肠上中段4例。4例接受再次手术的患者均痊愈出院，随访3~48个月，1例人工血管旁路闭塞但无下肢严重缺血，无其他严重并发症。

继发性腹主动脉瘤肠瘘是腹主动脉瘤术后罕见的严重并发症，经充分的抗炎准备后建立解剖外旁路并及时移除植入物是有效的治疗手段。

To summarize our experience in the treatment of secondary aortoenteric fistula (AEF) after endovascular repair of abdominal aortic aneurysm.

The data of six patients with secondary AEF enrolled in our hospital from January 2000 to December 2014 were retrospectively analyzed. The male to female ratio was 5∶1, with an average age of (66.7±6.7) years (58 to 77 years). Four patients had once received endovascular aorta repair (EVAR), while 2 received open surgery, for abdominal aortic aneurysms. The chief complaint was repeated fever for 1 to 27 months after previous operation. Only three patients were accurately diagnosed as secondary AEF for "herald hemorrhage" or signs of "graft invasion of the intestine" on CT scan. Other 3 patients were diagnosed as prosthesis infection on admission, of whom two patients refused re-operation. In total 4 patients received extra-anatomic bypass, prosthesis excision and intestine repair. Postopratively one patient with simultaneous aorto-vesical fistula received bladder repair as well.

The AEF located at the third portion of duodenum in 2 patients, at upper or middle part of jejunum in 3 patients and at middle ileum in 1 patient. The two patients who gave up died within 2 months, while the other four patients who received re-operation recovered uneventfully. During 3 to 48 months follow-up, 1 bypass occlusion occurred without severe lower extremity ischemia. No other serious complications were observed.

Secondary AEF is a rare but fatal complication after open or endovascular repair of abdominal aortic aneurysm. Extra-anatomic bypass and excision of the contaminated prosthesis is a reliable management.