title: Secondary aortoenteric fistulas versus paraprosthetic erosions: is bleeding associated with a worse outcome?
abstract: BACKGROUND
  Direct communication between an aortic prosthesis and the gastrointestinal (GI) tract may present with GI bleeding (aortoenteric fistulas [AEF]) or be incidental to a graft infection (paraprosthetic erosions [PPE]). The purposes of this study were to compare the outcomes of AEF versus PPE and to determine predictors of mortality associated with these lesions.
  
  
  METHODS
  Since 1992, 38 patients (23 men, 15 women; mean age 67 years) presented with AEF (n=16) or PPE (n=22).
  
  
  RESULTS
  After complete graft excision, 26 patients (8 AEF, 18 PPE) underwent in situ revascularization using femoral vein (n=24) or rifampin-soaked prosthetic graft (n=2); 12 (8 AEF, 4 PPE) underwent extraanatomic bypass. There was no significant difference in mortality for AEF versus PPE (38% versus 36%). Postoperative complications developed in 25 (66%) patients, including 10 (26%) with GI complications requiring reintervention (5 colon necrosis, 5 duodenal bleed or leak). There were no differences between AEF and PPE in operative transfusions, operative times, GI complications, ICU stay, hospital stay, or final discharge status. Multivariate stepwise logistic regression analysis revealed that GI complications (odds ratio [OR], 52.5; 95% CI, 3.5 to 781; p=0.004) and age (OR, 1.2; 95% CI, 1.02 to 1.3; p=0.026) were the only independent predictors of in-hospital mortality.
  
  
  CONCLUSIONS
  Surgical management of AEF and PPE should be tailored to patient illness and the extent of graft infection. Mortality from both lesions is dependent on patient and technical factors, not on the mode of presentation.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9031, USA.
authors.forename: R James
authors.initials: RJ
authors.lastname: Valentine
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Timaran
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Modrall
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Smith
authors.forename: Frank R
authors.initials: FR
authors.lastname: Arko
authors.forename: G Patrick
authors.initials: GP
authors.lastname: Clagett
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000401:mortality* / Q000601:surgery; D020878:Device Removal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007412:Intestinal Fistula / Q000401:mortality* / Q000601:surgery; D008297:Male; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000401:mortality* / Q000601:surgery; D012086:Reoperation; D016019:Survival Analysis; D016157:Vascular Fistula / Q000150:complications / Q000401:mortality* / Q000601:surgery