Aortoduodenal fistula arising from the dilatation of a knitted Dacron graft: report of a case.

A fatal aortoduodenal fistula occurred in a 72-year-old man who underwent a repair of an abdominal aortic aneurysm 16 years previously with a 20 x 10 mm bifurcated knitted Dacron graft. The aortic part of his bifurcated graft had dilated to 40 mm in diameter, with a discrepancy of 20 mm in the diameter between the graft and infrarenal aorta. The fourth portion of the duodenum adhered to the left side of the anastomosis, where the aortoenteric fistula had occurred. We believe that the graft dilatation was the cause of the anastomotic failure, although other factors such as atherosclerotic degeneration of the host aorta should also be considered. Knitted Dacron grafts that have been implanted for more than 10 years should therefore be monitored carefully because they have an inherent tendency to dilate, especially those manufactured before 1981.