title: In situ repair of aortobronchial, aortoesophageal, and aortoenteric fistulae with cryopreserved aortic homografts.
abstract: OBJECTIVE
  The surgical treatment of fistulae that originate from aortic aneurysms or prosthetic aortic grafts carries a high mortality rate. We investigated whether in situ repair with cryopreserved aortic homografts would improve the outcome.
  
  
  METHODS
  Between April 1994 and June 1996, 11 patients (mean age, 62 +/- 10 years) with aortobronchial, aortoesophageal, or aortointestinal fistulae originating from mycotic aneurysms (five of 12) or prosthetic aortic grafts (six of 12) underwent in situ replacement of the thoracic (seven of 10) or abdominal (four of 10) aorta with homografts. Emergency surgery was performed in eight of 11 patients (73%).
  
  
  RESULTS
  The hospital mortality rate was 9%; there was one sudden cardiac death on the seventh postoperative day. The mean hospital stay was 42 +/- 26 days (range, 21 to 90 days). After surgery, antibiotics were given for 38 +/- 6 days (range, 28 to 42 days). Neither reinfection, suture line rupture, nor anastomotic aneurysms were observed by magnetic resonance angiography, computed tomography, angiography, or transesophageal echocardiography after 14.3 +/- 8.2 months (range, 6 to 31 months). In one patient, percutaneous vascular stent placement was necessary after 18 months for an anastomotic stenosis of a thoracic homograft.
  
  
  CONCLUSIONS
  In situ repair with cryopreserved aortic homografts seems to be a promising step in the treatment of aortobronchial, aortoesophageal, and aortointestinal fistulae. This technique has a low operative mortality rate and may prevent reinfection.
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
authors.forename: P R
authors.initials: PR
authors.lastname: Vogt
authors.forename: T
authors.initials: T
authors.lastname: Pfammatter
authors.forename: R
authors.initials: R
authors.lastname: Schlumpf
authors.forename: M
authors.initials: M
authors.lastname: Genoni
authors.forename: A
authors.initials: A
authors.lastname: Künzli
authors.forename: D
authors.initials: D
authors.lastname: Candinas
authors.forename: G
authors.initials: G
authors.lastname: Zünd
authors.forename: M
authors.initials: M
authors.lastname: Turina
mesh_terms: D000368:Aged; D001011:Aorta / Q000637:transplantation*; D001014:Aortic Aneurysm / Q000150:complications; D001018:Aortic Diseases / Q000209:etiology / Q000601:surgery*; D001983:Bronchial Fistula / Q000601:surgery*; D015925:Cryopreservation; D004937:Esophageal Fistula / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014656:Vascular Surgical Procedures / Q000401:mortality