BackgroundSecondary 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.MethodsThis 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.ResultsAcross 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).ConclusionIn 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.

During bypass surgery for peripheral arterial occlusive disease and ischaemic heart disease, autologous graft conduit including great saphenous veins and radial arteries are frequently stored in solution. Endothelial damage adversely affects the performance and patency of autologous bypass grafts, and intraoperative graft storage solutions have been shown to influence this process. The distribution of storage solutions currently used amongst Cardiothoracic and Vascular Surgeons from Australia and New Zealand is not well defined in the literature. The aim of this study was to determine current practices regarding autologous graft storage and handling amongst this cohort of surgeons, and discuss their potential relevance in the context of early graft failure. From this survey, the most frequently used storage solutions were heparinized saline for great saphenous veins, and pH-buffered solutions for radial arteries. Duration of storage was 30–45 min for almost half of respondents, although responses to this question were limited. Further research is required to investigate whether ischaemic endothelial injury generates a prothrombotic state, whether different storage media can alter this state, and whether this is directly associated with clinical outcomes of interest such as early graft failure.