@article{3120354,
    title = "In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas",
    author = "Janko, M.R. and Woo, K. and Hacker, R.I. and Baril, D. and Bath, J. and Smeds, M.R. and Kashyap, V.S. and Szeberin, Z. and Magee, G.A. and Elsayed, R. and Wishy, A. and St. John, R. and Beck, A. and Farber, M. and Motta, F. and Zhou, W. and Lemmon, G. and Coleman, D. and Behrendt, C.-A. and Aziz, F. and Black, J. and Shutze, W. and Garrett, H.E., Jr. and De Caridi, G. and Liapis, C.D. and Geroulakos, G. and Kakisis, J. and Moulakakis, K. and Kakkos, S.K. and Obara, H. and Wang, G. and Rhéaume, P. and Davila, V. and Ravin, R. and DeMartino, R. and Milner, R. and Shalhub, S. and Jim, J. and Lee, J. and Dubuis, C. and Ricco, J.-B. and Coselli, J. and Lemaire, S. and Fatima, J. and Sanford, J. and Yoshida, W. and Schermerhorn, M.L. and Menard, M. and Belkin, M. and Blackwood, S. and Conrad, M. and Wang, L. and Crofts, S. and Nixon, T. and Wu, T. and Chiesa, R. and Bose, S. and Turner, J. and Moore, R. and Smith, J. and Ciocca, R. and Hsu, J. and Czerny, M. and Cullen, J. and Kahlberg, A. and Setacci, C. and Joh, J.H. and Senneville, E. and Garrido, P. and Sarac, T.P. and Rizzo, A. and Go, M.R. and Bjorck, M. and Gavali, H. and Wanhainen, A. and Lawrence, P.F. and Chung, J.",
    journal = "Journal of Vascular Surgery",
    year = "2021",
    volume = "73",
    number = "1",
    pages = "210-221.e1",
    publisher = "Mosby Year Book Inc",
    issn = "0741-5214, 1097-6809",
    doi = "10.1016/j.jvs.2020.04.515",
    keywords = "aminoglycoside;  cephalosporin;  daptomycin;  fluconazole;  metronidazole;  penicillin derivative;  quinolone derivative;  rifampicin;  vancomycin, adult;  aged;  antibiotic therapy;  aorta;  aortic graft;  aortic reconstruction;  aortic surgery;  aortointestinal fistula;  Article;  bleeding;  bypass surgery;  Candida;  cohort analysis;  controlled study;  excision;  extra anatomic bypass;  female;  graft infection;  hospital discharge;  human;  in situ bypass;  intermethod comparison;  major clinical study;  male;  mortality;  nonhuman;  operative blood loss;  peroperative complication;  postoperative complication;  priority journal;  prosthesis infection;  reinfection;  retrospective study;  secondary aortoenteric fistula;  Streptococcus;  treatment duration;  blood vessel fistula;  blood vessel transplantation;  clinical trial;  epidemiology;  follow up;  intestine fistula;  middle aged;  multicenter study;  procedures;  stent;  survival rate;  United States, Aged;  Blood Vessel Prosthesis Implantation;  Female;  Follow-Up Studies;  Humans;  Intestinal Fistula;  Male;  Middle Aged;  Retrospective Studies;  Stents;  Survival Rate;  United States;  Vascular Fistula",
    abstract = "Objective: The optimal revascularization modality in secondary aortoenteric fistula (SAEF) remains unclear in the literature. The purpose of this investigation was to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients with SAEF. Methods: A retrospective, multi-institutional study of SAEF from 2002 to 2014 was performed using a standardized database. Baseline demographics, comorbidities, and operative and postoperative variables were recorded. The primary outcome was long-term mortality. Descriptive statistics, Kaplan-Meier survival analysis, and univariate and multivariate analyses were performed. Results: During the study period, 182 patients at 34 institutions from 11 countries presented with SAEF (median age, 72 years; 79% male). The initial aortic procedures that resulted in SAEF were 138 surgical grafts (76%) and 42 endografts (23%), with 2 unknown; 102 of the SAEFs (56%) underwent complete excision of infected aortic graft material, followed by in situ (in-line) bypass (ISB), including antibiotic-soaked prosthetic graft (53), autogenous femoral vein (neoaortoiliac surgery; 17), cryopreserved allograft (28), and untreated prosthetic grafts (4). There were 80 patients (44%) who underwent extra-anatomic bypass (EAB) with infected graft excision. Overall median Kaplan-Meier estimated survival was 319 days (interquartile range, 20-2410 days). Stratified by EAB vs ISB, there was no significant difference in Kaplan-Meier estimated survival (P =.82). In comparing EAB vs ISB, EAB patients were older (74 vs 70 years; P =.01), had less operative hemorrhage (1200 mL vs 2000 mL; P =.04), were more likely to initiate dialysis within 30 days postoperatively (15% vs 5%; P =.02), and were less likely to experience aorta-related hemorrhage within 30 days postoperatively (3% aortic stump dehiscence vs 11% anastomotic rupture; P =.03). There were otherwise no significant differences in presentation, comorbidities, and intraoperative or postoperative variables. Multivariable Cox regression showed that the duration of antibiotic use (hazard ratio, 0.92; 95% confidence interval, 0.86-0.98; P =.01) and rifampin use at time of discharge (hazard ratio, 0.20; 95% confidence interval, 0.05-0.86; P =.03) independently decreased mortality. Conclusions: These data suggest that ISB does not offer a survival advantage compared with EAB and does not decrease the risk of postoperative aorta-related hemorrhage. After repair, <50% of SAEF patients survive 10 months. Each week of antibiotic use decreases mortality by 8%. Further study with risk modeling is imperative for this population. © 2020 Society for Vascular Surgery"
}