title: 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.affiliation: Vascular Surgery, Scientific Institute H. San Raffaele, Vita-Salute University School of Medicine, Via Olgettina 60, 20132 Milano, MI, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Chiesa
authors.forename: G
authors.initials: G
authors.lastname: Melissano
authors.forename: E M
authors.initials: EM
authors.lastname: Marone
authors.forename: M M
authors.initials: MM
authors.lastname: Marrocco-Trischitta
authors.forename: A
authors.initials: A
authors.lastname: Kahlberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D003430:Cross-Sectional Studies; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D012086:Reoperation; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy