Midterm outcomes of surgical strategy for secondary aorto-enteric fistula

Annals of vascular surgery. Brief reports and innovations Pub Date : 2024-10-24 DOI:10.1016/j.avsurg.2024.100346

Shuhei Miura, Ayaka Arihara, Yutaka Iba, Tomohiro Nakajima, Junji Nakazawa, Tsuyoshi Shibata, Yu Iwashiro, Kei Mukawa, Nobuyoshi Kawaharada

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Abstract

Objectives

Our surgical strategy for secondary aorto-enteric fistula (sAEF) encompasses one-stage open repair consisting of in situ anatomical prosthetic graft replacement with omentopexy following fistula repair. This study aimed to evaluate the midterm outcomes of our comprehensive surgical strategies for sAEF in a single-center series.

Methods

Between 2010 and 2022, 16 patients (14 male individuals; median age, 76.3 years) who underwent surgical repair of sAEF were reviewed. Nine and seven patients previously underwent open repair (OR-AEF) and endovascular repair (EVAR-AEF) for abdominal aortic aneurysm (AAA), respectively.

Results

Among patients who underwent OR-AEF (56.3 %) and EVAR-AEF (43.7 %), there were no significant differences in all variables, except for age (74.2 ± 4.8 vs. 79.1 ± 4.6 years, p = 0.028), interval from primary operation for AAA (66.9 ± 16.3 vs. 12.0 ± 11.4 months, p = 0.043), and clinical presentation with melena (77.8 % vs. 28.6 %, p = 0.049). Thirteen (81.3 %) patients were repaired with in situ anatomical graft replacement, whereas three (18.7 %) patients were unintentionally repaired with extra-anatomical bypass grafting based on intraoperative findings. Fistula repair was performed with duodenectomy in 14 (87.6 %) patients, direct suture closure in 1 (6.2 %), and sigmoid colectomy in 1 (6.2 %). The in-hospital mortality rate was 25.0 %. The 1- and 5-year overall survival and AEF-related event-free survival rates were 72.7 % and 49.8 %, and 77.0 % and 67.4 %, respectively. Patients who underwent complete removal of the contaminated prosthesis required suprarenal aortic clamping more frequently (72.7 % vs. 0 %, p = 0.007) than those who underwent partial removal. However, most were discharged without further oral antibiotic treatment (72.7 % vs. 0 %, p = 0.007). Patients who underwent complete removal had higher 5-year AEF-related event-free survival rate than those who underwent partial removal (69.3 % vs. 25.0 %, p = 0.069).

Conclusions

Midterm outcomes of our surgical strategy may be acceptable in patients with sAEF. AEF-related event-free survival is potentially affected by complete infected prosthesis removal.

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继发性主动脉-肠瘘手术策略的中期疗效

目的我们对继发性肠主动脉瘘（sAEF）的手术策略包括一期开放式修复，包括原位解剖假体移植物置换和瘘管修复后的网膜成形术。本研究旨在评估单中心系列综合手术策略治疗 sAEF 的中期疗效。方法回顾了 2010 年至 2022 年期间接受手术修复 sAEF 的 16 例患者（14 例男性，中位年龄 76.3 岁）。结果在接受 OR-AEF （56.3%）和 EVAR-AEF （43.结果在接受 OR-AEF （56.3%）和 EVAR-AEF （43.7%）的患者中，除了年龄（74.2 ± 4.8 岁 vs. 79.1 ± 4.6 岁，P = 0.028）、AAA 初次手术间隔时间（66.9 ± 16.3 个月 vs. 12.0 ± 11.4 个月，P = 0.043）和临床表现为血流不畅（77.8% vs. 28.6%，P = 0.049）外，所有变量均无明显差异。13例（81.3%）患者采用了原位解剖移植置换术进行修复，而3例（18.7%）患者则根据术中发现无意中采用了解剖外旁路移植术进行修复。14例（87.6%）患者通过十二指肠切除术、1例（6.2%）直接缝合术和1例（6.2%）乙状结肠切除术进行了瘘管修补。院内死亡率为 25.0%。1年和5年总生存率和无AEF相关事件生存率分别为72.7%和49.8%，以及77.0%和67.4%。与部分切除假体的患者相比，完全切除受污染假体的患者需要进行肾上主动脉夹闭的比例更高（72.7% 对 0%，P = 0.007）。不过，大多数患者在出院时无需继续口服抗生素治疗（72.7% 对 0%，p = 0.007）。接受完全切除术的患者的 5 年 AEF 相关无事件生存率高于接受部分切除术的患者（69.3% 对 25.0%，p = 0.069）。完全切除感染假体可能会影响与AEF相关的无事件生存率。

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