title: Aortobronchial and aortoesophageal fistulae as risk factors in surgery of descending thoracic aortic aneurysms.
abstract: OBJECTIVE
  Assess outcome of patients with descending thoracic aortic aneurysms complicated by aortobronchial and aortoesophageal fistulae in comparison to patients undergoing repair of aortic aneurysms without fistulae.
  
  
  METHODS
  In a consecutive series of 145 patients (age 60 +/- 12 years) with repair of descending thoracic and thoracoabdominal aortic aneurysms, 11 patients (8%; age 63 +/- 9; NS) primarily presented for hematemesis and/or hemoptysis. In 8/11 patients (73%) an aortobronchial fistula was identified, and 3/11 patients (27%) suffered from an aortoesophageal fistula. Five of 11 patients (45%) had undergone previous aortic surgery in the same region.
  
  
  RESULTS
  Extent of aortic segments (range 1-8) replaced was 3.1 +/- 1.4 for all versus 2.6 +/- 0.9 for fistulae (NS). Aortic cross clamp time was 38 +/- 22 min for all versus 45 +/- 15 min for fistulae (NS). Mortality at 30 days was 18/145 (12%) for all versus 16/134 (12%) without fistulae versus 2/11 (18%) with fistulae (NS). Paraparesis and or paraplegia was observed in 11/145 (8%) for all versus 10/134 (7%) without fistulae versus 1/11 (9%) for cases with fistulae (NS). Nine additional patients died after hospital discharge, seven without fistulae and two with fistulae (days 80, and 120) bringing the 1-year mortality up to 23/134 (17%) without fistulae versus 4/11 (36%) with fistulae (NS). Further analysis shows that the 1-year mortality accounts for 1/8 patients (13%) with aorto-bronchial fistulae versus to 3/3 patients (100%) with aorto-esophageal fistulae (esophageal versus bronchial fistula: P = 0.018; esophageal versus no fistula: P = 0.006).
  
  
  CONCLUSIONS
  Outcome of patients suffering from descending thoracic aortic aneurysms complicated by aorto-bronchial fistulae can be similar to that without fistulae, whereas for cases complicated by aorto-esophageal fistulae the prognosis seems to remain poor even after successful hospital discharge.
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital, CHUV, Lausanne, Switzerland.
authors.forename: L K
authors.initials: LK
authors.lastname: von Segesser
authors.forename: T
authors.initials: T
authors.lastname: Tkebuchava
authors.forename: U
authors.initials: U
authors.lastname: Niederhäuser
authors.forename: A
authors.initials: A
authors.lastname: Künzli
authors.forename: M
authors.initials: M
authors.lastname: Lachat
authors.forename: M
authors.initials: M
authors.lastname: Genoni
authors.forename: P
authors.initials: P
authors.lastname: Vogt
authors.forename: R
authors.initials: R
authors.lastname: Jenni
authors.forename: M I
authors.initials: MI
authors.lastname: Turina
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001018:Aortic Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D001983:Bronchial Fistula / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D004452:Echocardiography; D004937:Esophageal Fistula / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011336:Probability; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed