Open or endovascular repair of aortoenteric fistulas? A multicentre comparative study.
Title | Open or endovascular repair of aortoenteric fistulas? A multicentre comparative study. |
Publication Type | Journal Article |
Year of Publication | 2011 |
Authors | Kakkos, S. K., Antoniadis P. N., Klonaris C. N., Papazoglou K. O., Giannoukas A. D., Matsagkas M. I., Kotsis T., Dervisis K., Gerasimidis T., Tsolakis I. A., & Liapis C. D. |
Journal | Eur J Vasc Endovasc Surg |
Volume | 41 |
Issue | 5 |
Pagination | 625-34 |
Date Published | 2011 May |
ISSN | 1532-2165 |
Keywords | Aged, Aged, 80 and over, Aorta, Abdominal, Aortic Diseases, Female, Follow-Up Studies, Humans, Intestinal Fistula, Male, Middle Aged, Retrospective Studies, Stents, Tomography, X-Ray Computed, Treatment Outcome, Vascular Fistula, Vascular Surgical Procedures |
Abstract | OBJECTIVES: To compare aortoenteric fistula (AEF) outcome after endovascular (EV-AEFR) or open repair (O-AEFR).DESIGN: Multicentre retrospective comparative study.MATERIALS/METHODS: 25 patients with AEF (24 secondary, 23 males, median age 75 years) after aortic surgery (median four years). Preoperative sepsis was evident in 19 cases. Eight patients were managed with EV-AEFR and 17 with O-AEFR.RESULTS: The two groups were comparable in preoperative characteristics. In-hospital mortality after EV-AEFR was lower compared to O-AEFR (0% and 35%, respectively, p = 0.13). Similarly, morbidity after EV-AEFR was lower compared to O-AEFR (25% and 77%, respectively, p = 0.028). There was a trend for worse recurrence-free, sepsis-free, re-operation-free and AEF-related death-free rates after EV-AEFR, while the early survival advantage of EV-AEFR was lost after two years and the overall long-term survival rates (perioperative mortality included) of the two groups were similar. Preoperative sepsis had no effect on recurrence and sepsis-free rates (p = 0.94 and p = 0.92, respectively), but it was associated with worse two year overall survival (24% vs 50%, p = 0.32). On multivariate analysis, the number of symptoms (two vs one) at presentation was the single predictor of worse re-operation rates, AEF-related and overall survival.CONCLUSIONS: EV-AEFR was associated with no postoperative mortality in this study and can achieve satisfactory short and long-term results, comparable to O-AEFR. Further trials should focus on the role of EV-AEFR in patients at high risk for O-AEFR, due to shock or co-morbidities, or as a bridging procedure. |
DOI | 10.1016/j.ejvs.2010.12.026 |
Alternate Journal | Eur J Vasc Endovasc Surg |
PubMed ID | 21324718 |