title: Outcome after endovascular stent graft repair of aortoenteric fistula: A systematic review.
abstract: BACKGROUND
  Aortoenteric fistula (AEF) is a critical clinical condition, which may present with gastrointestinal hemorrhage, with or without signs of sepsis. Conventional open surgical repair is associated with high morbidity and mortality. Endovascular stent graft repair has been attempted, but recurrent infection remains of major concern. We conducted a systematic review to assess potential factors associated with poor outcome after endovascular treatment.
  
  
  METHODS
  The English literature was searched using the MEDLINE electronic database up to April 2008. All studies reporting on the primary management of primary or secondary AEF with endovascular stent graft repair were considered.
  
  
  RESULTS
  Data were extracted from 33 reports that included 41 patients and were entered in the final analysis. Persistent/recurrent/new infection or recurrent hemorrhage developed in 44% of the patients, after a mean follow-up period of 13 months (range, 0.13-36). Secondary, as compared to primary, AEF had an almost threefold increased risk of persistent/recurrent infection. Evidence of sepsis preoperatively was found to be a factor indicating unfavorable outcome (P < .05). Persistent/recurrent/new infection after treatment was associated with worse 30-day and overall survival compared with those who did not develop sepsis (P < .05).
  
  
  CONCLUSIONS
  Endovascular stent graft repair of AEF was associated with a high incidence of infection or recurrent bleeding postoperatively. Evidence of sepsis preoperatively was indicating poor outcome.
authors.affiliation: Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece.
authors.forename: George A
authors.initials: GA
authors.lastname: Antoniou
authors.forename: Stylianos
authors.initials: S
authors.lastname: Koutsias
authors.forename: Stavros A
authors.initials: SA
authors.lastname: Antoniou
authors.forename: Andreas
authors.initials: A
authors.lastname: Georgiakakis
authors.forename: Miltos K
authors.initials: MK
authors.lastname: Lazarides
authors.forename: Athanasios D
authors.initials: AD
authors.lastname: Giannoukas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016154:Digestive System Fistula / Q000401:mortality / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000401:mortality / Q000601:surgery*