Τίτλος:
Open or endovascular repair of aortoenteric fistulas? A multicentre comparative study
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
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.
Περιοδικό:
European Journal of Vascular and Endovascular Surgery
Λέξεις-κλειδιά:
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
DOI:
10.1016/j.ejvs.2010.12.026
