Eradication of infection with the graft in situ is difficult and it may require removal. Anastomotic aneurysms result from partial or total disruption of the anastomosis. They usually result from infection or disruption of the suture line. Most are asymptomatic but some cause symptoms as a result of local pressure . If they are superficial they can usually be easily palpated.
Treatment requires a short segment bypass graft to remove the risk of rupture.
Most aorto-enteric fistulae present months or years after the initial vascular surgery. The most common site of erosion is at the proximal anastomosis of an aortic graft into the distal duodenum or duodeno-jejunal flexure. Any GI bleed in a patient with an intrabdominal vascular graft should raise suspicion of a aorto-enteric fistula. They often present with a moderate 'herald' bleed prior to an exsanguinating haemorrhage. The site of bleeding is beyond the reach of a conventional endoscope.