title: Thoracic endovascular aortic repair in management of aortoesophageal fistulas.
abstract: OBJECTIVE
  To provide a systematic review of the outcomes of thoracic endovascular aortic repair (TEVAR) for aortoesophageal fistula (AEF) and to identify prognostic factors associated with poor outcomes.
  
  
  METHODS
  Literature searches of the Embase, Medline, and Cochrane databases identified relevant articles reporting results of TEVAR for AEF. The main outcome measure was the composite of aortic mortality, recurrence of the AEF, and stent graft explantation. The secondary outcome measure was aortic-related mortality.
  
  
  RESULTS
  Fifty-five articles were integrated after a literature search identified 72 patients treated by TEVAR for AEFs. The technical success rate of TEVAR was 87.3%. The overall 30-day mortality was 19.4%. Prolonged antibiotics (>4 weeks) were administered in 80% of patients. Concomitant or staged resection or repair of the esophagus was performed in 44.4% of patients. Stent graft explantation was performed within the first month after TEVAR as a planned treatment in 11.1%. After a mean follow-up of 7.4 months (range, 1-33 months), the all-cause mortality was 40.2%, and the aortic-related mortality was 33.3. Prolonged antibiotic treatment (P = .001) and repair of AEFs due to a foreign body (P = .038) were associated with a significant lower aortic mortality. On univariate analysis, TEVAR and concomitant or staged adjunctive procedures (resection, repair of the esophagus, or a planned stent graft explantation) were associated with a significantly lower incidence of aortic-related mortality (P = .0121). When entered into a binary logistic regression analysis, prolonged antibiotic treatment was the only factor associated with a significant lower incidence of the endpoint (P = .003).
  
  
  CONCLUSIONS
  Late infection or recurrence of the AEF and associated mortality rates are high when TEVAR is used as a sole therapeutic strategy. Prolonged antibiotic treatment has a strong negative association with mortality. A strategy of a temporizing endovascular procedure to stabilize the patient in extremis, and upon recovery, an open surgical esophageal repair with or without stent graft explantation is advocated.
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom. Electronic address: ludoviccanaud@hotmail.com.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Canaud
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.
authors.forename: Baris Ata
authors.initials: BA
authors.lastname: Ozdemir
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.
authors.forename: William Wynter
authors.initials: WW
authors.lastname: Bee
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Bahia
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Holt
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.
authors.forename: Matt
authors.initials: M
authors.lastname: Thompson
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D020878:Device Removal; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D004937:Esophageal Fistula / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents