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J Vasc Surg. 2016 Aug;64(2):313-320.e1. doi: 10.1016/j.jvs.2016.04.008. Epub 2016 Jun 9.

Results from the Multicenter Study on Aortoenteric Fistulization After Stent Grafting of the Abdominal Aorta (MAEFISTO).

Author information

1
Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milano, Italy. Electronic address: kahlberg.andrea@hsr.it.
2
Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milano, Italy.
3
Vascular Surgery, Department of Surgery and Morphological Sciences, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy.
4
Vascular and Endovascular Surgery Division, Department of Surgery, "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
5
Department of Vascular Surgery, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Donato, Milano, Italy.
6
Vascular Surgery, Department of Surgery, Ospedali Civili Hospital, University of Brescia School of Medicine, Brescia, Italy.

Abstract

OBJECTIVE:

This study investigated the frequency, clinical features, therapeutic options, and results of aortoenteric fistulas (AEFs) developing after endovascular abdominal aortic repair (EVAR).

METHODS:

Eight Italian centers with an EVAR program participated in this retrospective multicenter study and collected data on AEFs that developed after a previous EVAR.

RESULTS:

A total of 3932 patients underwent EVAR between 1997 and 2013 at the participating centers. During the same period, 32 patients presented with an AEF during EVAR follow-up, 21 with original EVAR performed for atherosclerotic aneurysmal disease (ATS group) and 11 with the original EVAR performed for a postsurgical pseudoaneurysm (PSA group). The incidence of AEF development after EVAR was 0.46% in the ATS group and 3.9% in the PSA group. Anastomotic PSA as the indication to EVAR (P < .0001) and urgent/emergency EVAR (P = .01) were significantly associated with AEF development. Median time between EVAR and the AEF diagnosis was 32 months (interquartile range, 11-75 months) for the ATS group and 14 months (interquartile range, 10.5-21.5 months) for the PSA group. Among five AEF patients treated conservatively, two (40%) died, at 7 and 15 months, and the remaining three were alive at a median follow-up of 12 months. The AEF was treated surgically in 27 patients, including aortic stent graft explantation in all cases, in situ aortic reconstruction in 14 (52%), and extra-anatomic bypass in 13 (48%). Perioperative mortality was 37% (10 of 27). No additional aortic-related death was recorded in operated-on patients at a median follow-up of 28 months.

CONCLUSIONS:

Late AEFs rarely occur during EVAR follow-up, but the risk is significantly increased when EVAR is performed for PSA after previous aortic surgery and EVAR is performed as an emergency. Conservative and surgical treatment of post-EVAR AEF are both associated with high mortality. However, beyond the perioperative period, surgical correction of AEFs appears to be durable at midterm follow-up.

PMID:
27289529
DOI:
10.1016/j.jvs.2016.04.008
[Indexed for MEDLINE]
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