Midterm outcomes of surgical strategy for secondary aorto-enteric fistula
Objectives: Our surgical strategy for secondary aorto-enteric fistula (sAEF) encompasses one-stage open repair consisting of in situ anatomical prosthetic graft replacement with omentopexy following fistula repair. This study aimed to evaluate the midterm outcomes of our comprehensive surgical strat...
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| Format: | Article |
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Elsevier
2024-12-01
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| Series: | Annals of Vascular Surgery - Brief Reports and Innovations |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772687824000989 |
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| author | Shuhei Miura Ayaka Arihara Yutaka Iba Tomohiro Nakajima Junji Nakazawa Tsuyoshi Shibata Yu Iwashiro Kei Mukawa Nobuyoshi Kawaharada |
| author_facet | Shuhei Miura Ayaka Arihara Yutaka Iba Tomohiro Nakajima Junji Nakazawa Tsuyoshi Shibata Yu Iwashiro Kei Mukawa Nobuyoshi Kawaharada |
| author_sort | Shuhei Miura |
| collection | DOAJ |
| description | Objectives: Our surgical strategy for secondary aorto-enteric fistula (sAEF) encompasses one-stage open repair consisting of in situ anatomical prosthetic graft replacement with omentopexy following fistula repair. This study aimed to evaluate the midterm outcomes of our comprehensive surgical strategies for sAEF in a single-center series. Methods: Between 2010 and 2022, 16 patients (14 male individuals; median age, 76.3 years) who underwent surgical repair of sAEF were reviewed. Nine and seven patients previously underwent open repair (OR-AEF) and endovascular repair (EVAR-AEF) for abdominal aortic aneurysm (AAA), respectively. Results: Among patients who underwent OR-AEF (56.3 %) and EVAR-AEF (43.7 %), there were no significant differences in all variables, except for age (74.2 ± 4.8 vs. 79.1 ± 4.6 years, p = 0.028), interval from primary operation for AAA (66.9 ± 16.3 vs. 12.0 ± 11.4 months, p = 0.043), and clinical presentation with melena (77.8 % vs. 28.6 %, p = 0.049). Thirteen (81.3 %) patients were repaired with in situ anatomical graft replacement, whereas three (18.7 %) patients were unintentionally repaired with extra-anatomical bypass grafting based on intraoperative findings. Fistula repair was performed with duodenectomy in 14 (87.6 %) patients, direct suture closure in 1 (6.2 %), and sigmoid colectomy in 1 (6.2 %). The in-hospital mortality rate was 25.0 %. The 1- and 5-year overall survival and AEF-related event-free survival rates were 72.7 % and 49.8 %, and 77.0 % and 67.4 %, respectively. Patients who underwent complete removal of the contaminated prosthesis required suprarenal aortic clamping more frequently (72.7 % vs. 0 %, p = 0.007) than those who underwent partial removal. However, most were discharged without further oral antibiotic treatment (72.7 % vs. 0 %, p = 0.007). Patients who underwent complete removal had higher 5-year AEF-related event-free survival rate than those who underwent partial removal (69.3 % vs. 25.0 %, p = 0.069). Conclusions: Midterm outcomes of our surgical strategy may be acceptable in patients with sAEF. AEF-related event-free survival is potentially affected by complete infected prosthesis removal. |
| format | Article |
| id | doaj-art-df2d32068a454ec998fa7df52831fa0f |
| institution | Kabale University |
| issn | 2772-6878 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Vascular Surgery - Brief Reports and Innovations |
| spelling | doaj-art-df2d32068a454ec998fa7df52831fa0f2024-12-12T05:24:25ZengElsevierAnnals of Vascular Surgery - Brief Reports and Innovations2772-68782024-12-0144100346Midterm outcomes of surgical strategy for secondary aorto-enteric fistulaShuhei Miura0Ayaka Arihara1Yutaka Iba2Tomohiro Nakajima3Junji Nakazawa4Tsuyoshi Shibata5Yu Iwashiro6Kei Mukawa7Nobuyoshi Kawaharada8Correspondence author at: Department of Cardiovascular Surgery, Sapporo Medical University, S1 W16, Chuo-ku, Sapporo 060-8543, Japan.; Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo, JapanDepartment of Cardiovascular Surgery, Sapporo Medical University, Sapporo, JapanDepartment of Cardiovascular Surgery, Sapporo Medical University, Sapporo, JapanDepartment of Cardiovascular Surgery, Sapporo Medical University, Sapporo, JapanDepartment of Cardiovascular Surgery, Sapporo Medical University, Sapporo, JapanDepartment of Cardiovascular Surgery, Sapporo Medical University, Sapporo, JapanDepartment of Cardiovascular Surgery, Sapporo Medical University, Sapporo, JapanDepartment of Cardiovascular Surgery, Sapporo Medical University, Sapporo, JapanDepartment of Cardiovascular Surgery, Sapporo Medical University, Sapporo, JapanObjectives: Our surgical strategy for secondary aorto-enteric fistula (sAEF) encompasses one-stage open repair consisting of in situ anatomical prosthetic graft replacement with omentopexy following fistula repair. This study aimed to evaluate the midterm outcomes of our comprehensive surgical strategies for sAEF in a single-center series. Methods: Between 2010 and 2022, 16 patients (14 male individuals; median age, 76.3 years) who underwent surgical repair of sAEF were reviewed. Nine and seven patients previously underwent open repair (OR-AEF) and endovascular repair (EVAR-AEF) for abdominal aortic aneurysm (AAA), respectively. Results: Among patients who underwent OR-AEF (56.3 %) and EVAR-AEF (43.7 %), there were no significant differences in all variables, except for age (74.2 ± 4.8 vs. 79.1 ± 4.6 years, p = 0.028), interval from primary operation for AAA (66.9 ± 16.3 vs. 12.0 ± 11.4 months, p = 0.043), and clinical presentation with melena (77.8 % vs. 28.6 %, p = 0.049). Thirteen (81.3 %) patients were repaired with in situ anatomical graft replacement, whereas three (18.7 %) patients were unintentionally repaired with extra-anatomical bypass grafting based on intraoperative findings. Fistula repair was performed with duodenectomy in 14 (87.6 %) patients, direct suture closure in 1 (6.2 %), and sigmoid colectomy in 1 (6.2 %). The in-hospital mortality rate was 25.0 %. The 1- and 5-year overall survival and AEF-related event-free survival rates were 72.7 % and 49.8 %, and 77.0 % and 67.4 %, respectively. Patients who underwent complete removal of the contaminated prosthesis required suprarenal aortic clamping more frequently (72.7 % vs. 0 %, p = 0.007) than those who underwent partial removal. However, most were discharged without further oral antibiotic treatment (72.7 % vs. 0 %, p = 0.007). Patients who underwent complete removal had higher 5-year AEF-related event-free survival rate than those who underwent partial removal (69.3 % vs. 25.0 %, p = 0.069). Conclusions: Midterm outcomes of our surgical strategy may be acceptable in patients with sAEF. AEF-related event-free survival is potentially affected by complete infected prosthesis removal.http://www.sciencedirect.com/science/article/pii/S2772687824000989Secondary aorto-enteric fistulaAbdominal aortic aneurysmOpen repairEndovascular repairSepsis |
| spellingShingle | Shuhei Miura Ayaka Arihara Yutaka Iba Tomohiro Nakajima Junji Nakazawa Tsuyoshi Shibata Yu Iwashiro Kei Mukawa Nobuyoshi Kawaharada Midterm outcomes of surgical strategy for secondary aorto-enteric fistula Annals of Vascular Surgery - Brief Reports and Innovations Secondary aorto-enteric fistula Abdominal aortic aneurysm Open repair Endovascular repair Sepsis |
| title | Midterm outcomes of surgical strategy for secondary aorto-enteric fistula |
| title_full | Midterm outcomes of surgical strategy for secondary aorto-enteric fistula |
| title_fullStr | Midterm outcomes of surgical strategy for secondary aorto-enteric fistula |
| title_full_unstemmed | Midterm outcomes of surgical strategy for secondary aorto-enteric fistula |
| title_short | Midterm outcomes of surgical strategy for secondary aorto-enteric fistula |
| title_sort | midterm outcomes of surgical strategy for secondary aorto enteric fistula |
| topic | Secondary aorto-enteric fistula Abdominal aortic aneurysm Open repair Endovascular repair Sepsis |
| url | http://www.sciencedirect.com/science/article/pii/S2772687824000989 |
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