Spanos Konstantinos, Kouvelos George, Karathanos Christos, Matsagkas Miltiadis, Giannoukas Athanasios D
Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41334 Larissa, Greece.
Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41334 Larissa, Greece.
Semin Vasc Surg. 2017 Jun-Sep;30(2-3):80-84. doi: 10.1053/j.semvascsurg.2017.10.004. Epub 2017 Oct 26.
Aortoenteric fistula (AEF) is one of the most challenging diagnostic and therapeutic entities in vascular surgery. AEF can occur either primarily involving the aorta and the gastrointestinal tract or, more commonly, secondary to previous aortic reconstructive surgery. Traditionally, the treatment of AEF includes graft excision and extra-anatomic bypass surgery or in situ graft replacement. However, recently endovascular repair has emerged as an alternative therapeutic option. In this article, we present published and current evidence for endovascular repair of primary and secondary AEF. When endovascular treatment is applied where appropriate, early outcomes seem to be superior compared to open surgery. This benefit may be lost during long-term follow-up, implying that a staged approach with early conversion to in situ grafting may realize the best patient survival and morbidity. Lifelong administration of antibiotics is associated with a reduction in re-infection. An endovascular approach used as a bridging procedure in unstable patients is recommended, followed by definitive open therapy, if feasible, in patients with good life expectancy.
主动脉肠瘘（AEF）是血管外科中最具挑战性的诊断和治疗疾病之一。AEF可原发于主动脉和胃肠道，或更常见的是继发于既往主动脉重建手术。传统上，AEF的治疗包括移植物切除和解剖外旁路手术或原位移植物置换。然而，近年来血管内修复已成为一种替代治疗选择。在本文中，我们展示了已发表的和当前关于原发性和继发性AEF血管内修复的证据。在适当应用血管内治疗时，早期结果似乎优于开放手术。这种益处可能在长期随访中丧失，这意味着早期转换为原位移植的分期方法可能实现最佳的患者生存率和发病率。终身使用抗生素与再感染的减少有关。建议在不稳定患者中使用血管内方法作为桥接程序，如果可行，对于预期寿命良好的患者随后进行确定性开放治疗。
