Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand.
Department of Vascular Surgery, Wellington Hospital, Wellington, New Zealand.
ANZ J Surg. 2023 Oct;93(10):2363-2369. doi: 10.1111/ans.18441. Epub 2023 Apr 3.
Secondary aorto-enteric fistulae (SAEF) are a rare, complex and life-threatening complication following aortic repair. Traditional treatment strategy has been with open aortic repair (OAR), with emergence of endovascular repair (EVAR) as a potentially viable initial treatment option. Controversy exists over optimal immediate and long-term management.
This was a retrospective, observational, multi-institutional cohort study. Patients who had been treated for SAEF between 2003 and 2020 were identified using a standardized database. Baseline characteristics, presenting features, microbiological, operative, and post-operative variables were recorded. The primary outcomes were short and mid-term mortality. Descriptive statistics, binomial regression, Kaplan-Meier and Cox age-adjusted survival analyses were performed.
Across 5 tertiary centres, a total of 47 patients treated for SAEF were included, 7 were female and the median (range) age at presentation was 74 years (48-93). In this cohort, 24 (51%) patients were treated with initially with OAR, 15 (32%) with EVAR-first and 8 (17%) non-operatively. The 30-day and 1-year mortality for all cases that underwent intervention was 21% and 46% respectively. Age-adjusted survival analysis revealed no statistically significant difference in mortality in the EVAR-first group compared to the OAR-first group, HR 0.99 (95% CI 0.94-1.03, P = 0.61).
In this study there was no difference in all-cause mortality in patients who had OAR or EVAR as first line treatment for SAEF. In the acute setting, alongside broad-spectrum antimicrobial therapy, EVAR can be considered as an initial treatment for patients with SAEF, as a primary treatment or a bridge to definitive OAR.
主动脉修复术后继发的肠-主动脉瘘（SAEF）是一种罕见、复杂且危及生命的并发症。传统的治疗策略是开放性主动脉修复术（OAR），而血管内修复术（EVAR）作为一种潜在可行的初始治疗选择已逐渐兴起。目前对于其最佳即刻和长期管理仍存在争议。
这是一项回顾性、观察性、多机构队列研究。通过标准化数据库，确定了 2003 年至 2020 年间接受 SAEF 治疗的患者。记录了患者的基线特征、临床表现、微生物学、手术和术后变量。主要结局为短期和中期死亡率。采用描述性统计、二项回归、Kaplan-Meier 和 Cox 年龄调整生存分析。
在 5 家三级中心，共纳入 47 例 SAEF 患者，其中 7 例为女性，中位（范围）年龄为 74 岁（48-93 岁）。在该队列中，24 例（51%）患者最初接受 OAR 治疗，15 例（32%）接受 EVAR 治疗，8 例（17%）患者未接受手术治疗。所有接受干预的患者的 30 天和 1 年死亡率分别为 21%和 46%。年龄调整生存分析显示，EVAR 组与 OAR 组的死亡率无统计学差异，HR 0.99（95%CI 0.94-1.03，P=0.61）。
在本研究中，OAR 或 EVAR 作为 SAEF 的一线治疗，患者的全因死亡率无差异。在急性情况下，除了广谱抗菌治疗外，EVAR 可作为 SAEF 患者的初始治疗方法，无论是作为主要治疗方法还是作为确定性 OAR 的桥接治疗。
