Endovascular repair for aorto-enteric fistula: a bridge too far or a bridge to surgery?

Abstract

PURPOSE:

To review our experience of endovascular treatment of aorto-enteric fistula (AEF).

METHODS:

Between March 1999 and March 2005, 15 patients in five university and teaching hospitals in Belgium and The Netherlands were treated for AEF by endovascular repair. Twelve (80%) were male. The mean age was 67 years. Thirteen (87%) had had previous aortic or iliac surgery, 1.7-307 months before. All patients showed clinical or biochemical signs of bleeding. Eight (53%) were in shock, five (33%) had systemic signs of infection. Eight (53%) patients were treated in an emergency setting. Ten (67%) were treated with an aortouniiliac device, three (20%) with an aortobiiliac device, one with a tube graft and one with occluders only. All patients received antibiotics postoperatively for a prolonged period of time.

RESULTS:

All AEF were successfully sealed, the 30-days mortality was nil. Mean hospital stay was 20 (2-81) days. One patient died 2.7 months later of postoperative complications, one died of lung cancer. Until now, there are no signs of reinfection in four (27%) patients (mean follow-up 15.7 (1-44) months). However, reinfection or recurrent AEF occurred in nine (60%) patients after 9.5 (0.61-31) months. Seven patients were reoperated successfully, two patients died after reintervention.

CONCLUSION:

Endovascular sealing of AEF is a promising technique, which provides time to treat shock, local and systemic infection, and co-morbidity. This creates a better situation to perform open repair in the future with possibly better outcome. Danger of reinfection remains high. Endovascular sealing of AEF should, therefore, be seen as a bridge to open surgery when possible.

• Authors: M I L Danneels, H J M Verhagen, J A W Teijink, Ph Cuypers, A Nevelsteen, F E G Vermassen
• Journal: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (Eur J Vasc Endovasc Surg) Vol. 32 Issue 1 Pg. 27-33 (Jul 2006) ISSN: 1078-5884 [Print] England
• PMID: 16427330 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Anti-Bacterial Agents

Topics

• Aged
• Anastomosis, Surgical
• Anti-Bacterial Agents (therapeutic use)
• Aorta (surgery)
• Arterio-Arterial Fistula (drug therapy, surgery)
• Bacteremia (etiology)
• Blood Vessel Prosthesis Implantation
• Female
• Humans
• Iliac Artery (surgery)
• Intestinal Fistula (drug therapy, prevention & control, surgery)
• Male
• Postoperative Complications
• Prosthesis-Related Infections (drug therapy, prevention & control)
• Recurrence
• Renal Insufficiency (etiology)
• Reoperation
• Retrospective Studies
• Risk Assessment
• Survival Analysis