Forty Year Single Institution Experience With Secondary Aortoenteric Fistulas
Armin Farazdaghi, M.D.1, Manju Kalra, M.B.B.S1, Armin A. Tabiei1, Richard T. Rogers, M.D.1, Jill J. Colglazier, M.D.1, Bernardo C. Mendes, M.D.1, Randall R. DeMartino, M.D., M.S.1, Fahad Shuja, M.B.B.S1, Gustavo S. Oderich, M.D.2, Thomas C. Bower, M.D.1.
1Mayo Clinic, Rochester, MN, USA, 2The University of Texas Health Science Center at Houston, Houston, TX, USA.
Objectives: Aortoenteric fistulas and erosions (AEF) are a rare but significant complication of aortic surgery. The aim of this study was to assess outcomes of patients who presented with secondary AEF to our institution from 1980 until the present, with a focus on mortality following AEF repair, and nature of the index procedure - index open repair (IOR) versus index endovascular repair (IER).Methods: Data from consecutive patients presenting with secondary AEF from 1980 through 2021 were retrospectively analyzed. Patient demographics, presentation, co-morbidities, nature of index procedure, mode of repair and outcomes were collected utilizing medical records and the Accurint database. Results: A total of 85 patients (mean age 69.6, 78% male) were included in this study. AEFs were secondary to IOR in 68 patients and IER in 17. Of 85 patients, 75 (88%) underwent in-situ reconstruction (rifampin-soaked Dacron 53 (71%), cryopreserved allograft in 21 (28%), and femoral vein conduit 1) and 10 (12%) extra-anatomic bypasses with aortic graft excision. Patient demographics in patients with IOR versus IER demonstrated no statistically significant difference in age (69 ± 8 vs. 70 ± 13, p=0.80), male gender (75% vs. 88%, p=0.34), BMI, hypertension, hyperlipidemia, CAD, PAD, CKD, COPD, DM, or tobacco use. Patients with IOR were significantly more likely to present with hematemesis or melena (57% vs 12%, p=0.0008) and at a longer time following index procedure (102 ± 77 vs. 53 ± 55 months, p=0.016) compared to those with IER. Thirty-day mortality of the entire cohort was 8.2% and median survival was 5.6 years. Patients with IOR had a 30-day mortality of 10.3% and median survival of 4.9 years compared to those with IER with 5.9% and 5.7 years, respectively. In 19 patients treated before the year 2000, 30-day mortality was 21% compared to 4.5% after year 2000.Conclusion:Patients who underwent IORs were more likely to present symptomatically with signs of upper or lower GI hemorrhage and at a longer time period from the index procedure. A lower 30-day mortality among patients treated after the year 2000 and those with IER was observed in this experience.
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