As the number of patients treated with endovascular abdominal aortic repair (EV AR) is considerably growing in recent years, related complications are observed with increasing frequency. Among these, aortoenteric fistula (AEF ) is known to be a dramatic and highly lethal event, but evidence in the literature is scant and mainly based on single-centers case reports. Aim of this study is to investigate the incidence, clinical features, therapeutic options, and outcomes of AEF developing after EV AR. Materials/Methods: A retrospective multicenter study was conducted among eight Italian universities and hospital centers with an abdominal aortic endovascular program, to collect data on AEF developed after EV AR performed for non-infectious disease. Results: Among 3,932 patients who underwent EV AR between 1997 and 2013, 32 (0.8%; 27 males, mean age 72 ± 8 years) developed an AEF . Median time between EV AR and AEF formation was 18.5 months (interquartile range, IQR : 10.5 – 63.5 months). Both anastomotic pseudoaneurysm as the indication to EV AR, and urgent / emergent EV AR resulted significantly associated with AEF development (34% vs. 5%, P < 0.0001; and 22% vs. 8%, P = 0.01; respectively). Among 5 patients treated conservatively, 2 (40%) died at 7 and 15 months respectively, while the other 3 are alive at a median follow-up of 12 months (IQR : 7 – 15). The remaining 27 patients underwent AEF surgical treatment, with a perioperative mortality of 37% (n = 10). No additional aortic-related death was recorded in operated patients at a median follow-up of 28 months (IQR : 14 – 42). Conclusion: L ate AEF may occur in less than 1% of patients submitted to EV AR, with an increased risk in case of emergent EV AR or performed for pseudoaneurysm following previous aortic surgery. Both conservative and surgical treatment of post-EV AR AEF is associated with high mortality. However, beyond the perioperative period, surgical correction of AEF appears to be durable at mid-term follow-up.

Aorto-Enteric Fistula following Endovascular Aortic Repair: Results from the Multicenter study on Aorto-Enteric FI stulization after ST ent-grafting Of the abdominal aorta (MAEFISTO )

2015-01-01

Abstract

As the number of patients treated with endovascular abdominal aortic repair (EV AR) is considerably growing in recent years, related complications are observed with increasing frequency. Among these, aortoenteric fistula (AEF ) is known to be a dramatic and highly lethal event, but evidence in the literature is scant and mainly based on single-centers case reports. Aim of this study is to investigate the incidence, clinical features, therapeutic options, and outcomes of AEF developing after EV AR. Materials/Methods: A retrospective multicenter study was conducted among eight Italian universities and hospital centers with an abdominal aortic endovascular program, to collect data on AEF developed after EV AR performed for non-infectious disease. Results: Among 3,932 patients who underwent EV AR between 1997 and 2013, 32 (0.8%; 27 males, mean age 72 ± 8 years) developed an AEF . Median time between EV AR and AEF formation was 18.5 months (interquartile range, IQR : 10.5 – 63.5 months). Both anastomotic pseudoaneurysm as the indication to EV AR, and urgent / emergent EV AR resulted significantly associated with AEF development (34% vs. 5%, P < 0.0001; and 22% vs. 8%, P = 0.01; respectively). Among 5 patients treated conservatively, 2 (40%) died at 7 and 15 months respectively, while the other 3 are alive at a median follow-up of 12 months (IQR : 7 – 15). The remaining 27 patients underwent AEF surgical treatment, with a perioperative mortality of 37% (n = 10). No additional aortic-related death was recorded in operated patients at a median follow-up of 28 months (IQR : 14 – 42). Conclusion: L ate AEF may occur in less than 1% of patients submitted to EV AR, with an increased risk in case of emergent EV AR or performed for pseudoaneurysm following previous aortic surgery. Both conservative and surgical treatment of post-EV AR AEF is associated with high mortality. However, beyond the perioperative period, surgical correction of AEF appears to be durable at mid-term follow-up.
2015
Andrea Kahlberg, E. Rinaldi; P. Sirignano, S. Trimarchi; S. Bonardelli, E. Cervi; G. Melissano, R. Chiesa
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11383/2023543
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