title: Endovascular management of arterioenteric fistulas: a systemic review and meta-analysis of the literature.
abstract: OBJECTIVE
  To present a systemic review and meta-analysis investigating the outcomes of endovascular management of arterioenteric fistula (AEF).
  
  
  METHODS
  Literature review on AEF management with endovascular surgery using MEDLINE search, including two cases managed by the authors.
  
  
  RESULTS
  Fifty-nine patients (50 men; mean age 68 years, range 23-90) were identified. AEF was successfully managed in 55 (93%) patients and 30-day mortality was 8.5% (5/59). During follow-up, 10 (19%) patients developed recurrent bleeding, which occurred more often in AEFs due to cancer. The freedom from recurrence rate at 12 and 24 months was 71.5%. Seventeen (32%) patients developed sepsis, which was managed conservatively in 8 (7 successful). Freedom from sepsis at 12 and 24 months was 64%, while the freedom from combined recurrence and sepsis at 12 and 24 months was 59%. Patients who did not have intestinal repair had a higher rate of combined recurrence and sepsis compared to patients who did; the freedom from combined recurrence and sepsis at 12 months was 52% for patients not having intestinal repair versus 100% in patients who did (p = 0.022). Total AEF-related mortality rates at 12 and 24 months were 15% and 19%, respectively, significantly worse when AEF recurred (p = 0.001). Overall survival rates at 12 and 24 months were 68% and 52%; prognosis was worse in patients with perioperative sepsis, large bowel fistulization, tube graft placement, no intestinal repair, and recurrent AEF.
  
  
  CONCLUSIONS
  Endovascular management of AEF can achieve satisfactory short and midterm results, better than those historically reported for open surgery, despite the high rate of recurrent bleeding and sepsis. Further investigation of the role played by intestinal repair is warranted.
authors.affiliation: Department of Vascular Surgery, University Hospital of Patras, Rio, Patras Greece. kakkos@upatras.gr
authors.forename: Stavros K
authors.initials: SK
authors.lastname: Kakkos
authors.forename: Spyros
authors.initials: S
authors.lastname: Papadoulas
authors.forename: Ioannis A
authors.initials: IA
authors.lastname: Tsolakis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007412:Intestinal Fistula / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000401:mortality / Q000601:surgery*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents