Open or Endovascular Repair of Aortoenteric Fistulas? A Multicentre Comparative Study
| Autor: | Christos D. Liapis, Thomas Kotsis, Konstantinos O. Papazoglou, Athanasios D. Giannoukas, Thomas Gerasimidis, Stavros K. Kakkos, Ioannis A. Tsolakis, Miltiadis Matsagkas, Pavlos Antoniadis, Konstantinos Dervisis, Christos Klonaris |
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| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Multivariate analysis Intestinal Fistula/diagnosis/*surgery Aortic Diseases Aortoenteric fistula Aorta Abdominal Vascular Surgical Procedures/*methods Sepsis Endovascular repair Intestinal Fistula Aortic Diseases/diagnosis/*surgery Overall survival Humans Survival advantage Medicine In patient Vascular Fistula/diagnosis/*surgery Aged Retrospective Studies Vascular Fistula Medicine(all) Aged 80 and over business.industry Open repair Stents Perioperative Middle Aged medicine.disease Surgery Treatment Outcome cardiovascular system Female Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures Follow-Up Studies |
| Zdroj: | European Journal of Vascular and Endovascular Surgery. 41:625-634 |
| ISSN: | 1078-5884 |
| DOI: | 10.1016/j.ejvs.2010.12.026 |
| Popis: | 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. Eur J Vasc Endovasc Surg |
| Databáze: | OpenAIRE |
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