TY - JOUR
TI - Open or endovascular repair of aortoenteric fistulas? A multicentre comparative study
AU - Kakkos, S.K.
AU - Antoniadis, P.N.
AU - Klonaris, C.N.
AU - Papazoglou, K.O.
AU - Giannoukas, A.D.
AU - Matsagkas, M.I.
AU - Kotsis, T.
AU - Dervisis, K.
AU - Gerasimidis, T.
AU - Tsolakis, I.A.
AU - Liapis, C.D.
JO - European Journal of Vascular and Endovascular Surgery
PY - 2011
VL - 41
TODO - 5
SP - 625-634
PB - 
SN - 1078-5884, 1532-2165
TODO - 10.1016/j.ejvs.2010.12.026
TODO - antibiotic agent, abdominal aorta aneurysm;  abscess;  adult;  aged;  anastomosis leakage;  antibiotic therapy;  aorta surgery;  aortointestinal fistula;  article;  clinical article;  controlled study;  digestive system fistula;  endovascular surgery;  female;  fever;  follow up;  heart infarction;  human;  intermethod comparison;  intestine surgery;  leg ischemia;  Leriche syndrome;  male;  morbidity;  multiple organ failure;  outcome assessment;  overall survival;  peroperative complication;  postoperative hemorrhage;  predictive value;  preoperative period;  priority journal;  prosthesis infection;  recurrent disease;  reoperation;  respiratory failure;  retrospective study;  sepsis;  surgical mortality;  survival rate;  survival time;  thrombosis, 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
TODO - 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. © 2010 European Society for Vascular Surgery.
ER -