title: Open or endovascular repair of aortoenteric fistulas? A multicentre comparative study.
abstract: OBJECTIVE
  To compare aortoenteric fistula (AEF) outcome after endovascular (EV-AEFR) or open repair (O-AEFR).
  
  
  METHODS
  Multicentre retrospective comparative study.
  
  
  METHODS
  25 patients with AEF (24 secondary, 23 males, median age 75 years) after aortic surgery (median four years). Preoperative sepsis was evident in 19 cases. Eight patients were managed with EV-AEFR and 17 with O-AEFR.
  
  
  RESULTS
  The two groups were comparable in preoperative characteristics. In-hospital mortality after EV-AEFR was lower compared to O-AEFR (0% and 35%, respectively, p = 0.13). Similarly, morbidity after EV-AEFR was lower compared to O-AEFR (25% and 77%, respectively, p = 0.028). There was a trend for worse recurrence-free, sepsis-free, re-operation-free and AEF-related death-free rates after EV-AEFR, while the early survival advantage of EV-AEFR was lost after two years and the overall long-term survival rates (perioperative mortality included) of the two groups were similar. Preoperative sepsis had no effect on recurrence and sepsis-free rates (p = 0.94 and p = 0.92, respectively), but it was associated with worse two year overall survival (24% vs 50%, p = 0.32). On multivariate analysis, the number of symptoms (two vs one) at presentation was the single predictor of worse re-operation rates, AEF-related and overall survival.
  
  
  CONCLUSIONS
  EV-AEFR was associated with no postoperative mortality in this study and can achieve satisfactory short and long-term results, comparable to O-AEFR. Further trials should focus on the role of EV-AEFR in patients at high risk for O-AEFR, due to shock or co-morbidities, or as a bridging procedure.
authors.affiliation: Department of Vascular Surgery, University Hospital of Patras, Greece. kakkos@upatras.gr
authors.forename: S K
authors.initials: SK
authors.lastname: Kakkos
authors.forename: P N
authors.initials: PN
authors.lastname: Antoniadis
authors.forename: C N
authors.initials: CN
authors.lastname: Klonaris
authors.forename: K O
authors.initials: KO
authors.lastname: Papazoglou
authors.forename: A D
authors.initials: AD
authors.lastname: Giannoukas
authors.forename: M I
authors.initials: MI
authors.lastname: Matsagkas
authors.forename: T
authors.initials: T
authors.lastname: Kotsis
authors.forename: K
authors.initials: K
authors.lastname: Dervisis
authors.forename: T
authors.initials: T
authors.lastname: Gerasimidis
authors.forename: I A
authors.initials: IA
authors.lastname: Tsolakis
authors.forename: C D
authors.initials: CD
authors.lastname: Liapis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*