Vascular Surgery, Scientific Institute H. San Raffaele, Vita-Salute University School of Medicine, Milano, Italy.
J Vasc Surg. 2010 May;51(5):1195-202. doi: 10.1016/j.jvs.2009.10.130. Epub 2010 Mar 20.
Even when promptly recognized and treated, aortoesophageal (AEF) and aortobronchial (ABF) fistulae are highly lethal conditions. Open surgical repair also carries a high risk of mortality and morbidity. Several alternative strategies have been recently reported in the literature including thoracic endovascular aortic repair (TEVAR). However, relatively little is known about results of TEVAR for AEF and ABF due to their rarity and the lack of large surveys.
A voluntary national survey was conducted among Italian universities and hospital centers with an endovascular program. Questionnaires were distributed by e-mail to participating centers and aimed to evaluate the results of endovascular repair of established AEF or ABF.
Seventeen centers agreed to participate and provided data on their patients. Between 1998 and 2008, a total of 1138 patients were treated with TEVAR. In 25 patients (2.2%), the indication to treatment was an AEF and/or an ABF. In 10 of these cases (40%), an associated open surgical procedure was also performed. Thirty-day mortality rate of AEF/ABF endovascular repair was 28% (7 cases). No cases of paraplegia or stroke were observed. Mean follow-up was 22.6 months (range, 1-62). Actuarial survival at 2 years was 55%. Among the 18 initial survivors, five patients (28%) underwent reintervention due to late TEVAR failure.
Stent grafting for AEF and ABF represents a viable option in emergent and urgent settings. However, further esophageal or bronchial repair is necessary in most cases. Despite less invasive attempts, mortality associated with these conditions remains very high.
即使及时发现并治疗，主动脉食管（AEF）和主动脉支气管（ABF）瘘也是高度致命的情况。开放性手术修复也有很高的死亡率和发病率。最近文献中报道了几种替代策略，包括胸主动脉腔内修复术（TEVAR）。然而，由于其罕见性和缺乏大型调查，对于 TEVAR 治疗 AEF 和 ABF 的结果了解相对较少。
在意大利的大学和医院中心进行了一项自愿的全国性调查，这些中心都有血管内项目。通过电子邮件向参与中心分发问卷，旨在评估已建立的 AEF 或 ABF 的血管内修复结果。
17 个中心同意参与并提供了他们患者的数据。在 1998 年至 2008 年期间，共有 1138 例患者接受了 TEVAR 治疗。在 25 例患者（2.2%）中，治疗的适应症是 AEF 和/或 ABF。在这些病例中有 10 例（40%），还进行了开放性手术。AEF/ABF 血管内修复的 30 天死亡率为 28%（7 例）。未观察到截瘫或中风病例。平均随访时间为 22.6 个月（范围 1-62 个月）。2 年的生存率为 55%。在最初的 18 名幸存者中，有 5 名患者（28%）因晚期 TEVAR 失败而再次介入。
在紧急和紧急情况下，支架移植治疗 AEF 和 ABF 是一种可行的选择。然而，在大多数情况下，还需要进行食管或支气管修复。尽管尝试了较少的侵入性方法，但这些疾病的死亡率仍然很高。
