Aorto-oesophageal and aortobronchial fistulae following thoracic endovascular aortic repair: a national survey.

Abstract

OBJECTIVE:

We evaluated the incidence of aorto-oesophageal (AEF) and aortobronchial (ABF) fistulae after thoracic endovascular aortic repair (TEVAR), and investigated their clinical features, determinants, therapeutic options and results.

METHODS:

We conducted a voluntary national survey among Italian universities and hospital centres with a thoracic endovascular programme.

RESULTS:

Thirty-nine centres were contacted, and 17 participated. Of the patients who underwent TEVAR between 1998 and 2008, 19/1113 (1.7%) developed AEF/ABF. Among indications to TEVAR, aortic pseudo-aneurysm was associated with the development of late AEF/ABF (P = 0.009). Further, emergent and complicated procedures resulted in increased risk of AEF/ABF (P = 0.008 and P < 0.001, respectively). Eight patients were treated conservatively, all of whom died within 30 days. Eleven patients underwent AEF/ABF surgical treatment, with a perioperative mortality of 64% (7/11). At a mean follow-up of 17.7 +/- 12.5 months, overall survival was 16% (3/19).

CONCLUSIONS:

The incidence of AEF and ABF following TEVAR is not negligible, and is comparable to that following open repair. This finding warrants an ad hoc long-term follow-up after TEVAR, particularly in patients submitted to emergent and complicated procedures. Both surgical and endovascular treatment of AEF/ABF are associated with high mortality. However, conservative treatment does not appear to be a viable option.

• Authors: R Chiesa, G Melissano, E M Marone, M M Marrocco-Trischitta, A Kahlberg
• Journal: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (Eur J Vasc Endovasc Surg) Vol. 39 Issue 3 Pg. 273-9 (Mar 2010) ISSN: 1532-2165 [Electronic] England
• PMID: 20096612 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Aorta, Thoracic (surgery)
• Aortic Diseases (mortality, surgery)
• Blood Vessel Prosthesis Implantation (adverse effects, mortality)
• Bronchial Fistula (diagnosis, etiology, mortality, therapy)
• Cross-Sectional Studies
• Esophageal Fistula (diagnosis, etiology, mortality, therapy)
• Female
• Health Care Surveys
• Humans
• Incidence
• Italy (epidemiology)
• Male
• Reoperation
• Survival Analysis
• Time Factors
• Treatment Outcome
• Vascular Fistula (diagnosis, etiology, mortality, therapy)