Aorto-enteric and arterio-ureteral fistulas of infectious origin: a exploratory systematic review with PICO questions
DOI:
https://doi.org/10.70577/06667998Keywords:
aorto-enteric fistula; arterio-ureteral fistula; infection; vascular erosion; systematic review; PICOAbstract
Aorto-enteric fistulas (AEF) and arterio-ureteral fistulas (AUF) are rare but potentially lethal entities. AEF is classically associated with infected aortic grafts, while AUF is related to chronic ureteral stents and pelvic oncologic surgery (Bergqvist et al., 2001; Chaulagain et al., 2025). Both share a common pathophysiological mechanism: erosion of a vascular structure by an adjacent infectious or inflammatory process (Megaloikonomos et al., 2017; Shamseldin et al., 2024). To synthesize available evidence on both entities through an exploratory systematic review structured with PICO questions, explore their pathophysiological convergence points, and propose an integrated conceptual framework. Methods: Exploratory systematic review following PRISMA 2020 (Page et al., 2021). Two PICO questions were formulated. Systematic search in PubMed/MEDLINE (January 2000 to November 2026). Case reports, series, and reviews on AEF and AUF of infectious or inflammatory origin were included. Methodological quality was assessed using JBI. Forty-seven records were identified; after screening, 8 studies were included. Infectious AEF originates mainly from aortic graft infection with mechanical erosion of the adjacent bowel, with mortality reaching 100% without treatment (Chaulagain et al., 2025). AUF presents with intermittent massive hematuria and is most frequently located in the common iliac artery, with a review of 540 cases confirming its association with ureteral stents and pelvic surgery (Shamseldin et al., 2024). AEF and AUF converge on a common pathophysiological mechanism of vascular erosion by infection or inflammation. Early recognition and multidisciplinary management are essential (Koskas et al., 2025). Prospective studies evaluating unified strategies are required.
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