Editor's Choice – Management of Secondary Aorto-enteric and Other Abdominal Arterio-enteric Fistulas: A Review and Pooled Data Analysis

Abstract

Endovascular surgery, where appropriate, is associated with better early survival than open surgery for secondary AEFs. Most of this benefit is lost during long-term follow-up, implying that a staged approach with early conversion to in situ vein grafting may achieve the best results in selected patients.

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections

“…132 In a systematic review of the literature conducted in 2016, 216 studies representing 823 patients with AEnF were compiled. 134 Bleeding was the most common symptom (71.7%), followed by sepsis (39.7%) and haemorrhagic shock (33.1%). Allograft related re-intervention rates were found in up to 55% of patients after five years (Table 8).…”

Imaging work-up and endovascular treatment options for aorto-enteric fistula

“…Prior studies have found that, among the aforementioned surgical techniques, in situ repair using a vein graft or prosthetic graft is associated with the lowest long-term mortality rates and lowest rates of sepsis, especially if the graft is covered with omentum. However, even in situ vein grafting for SAEF is associated with an in-hospital mortality rate of 32%, which is considerably higher than the 7% in-hospital mortality of endovascular treatment of SAEF (3,29). Despite decades of attempted improvement and development of novel techniques, morbidity and mortality associated with open surgical repair of SAEF remain major obstacles (28,(30)(31)(32).…”

“…Some of this benefit is lost when analyzing long-term outcome data, primarily due to the increased rates of recurrence and sepsis associated with some endovascular techniques. Despite this, long term survival rates still appear higher with endovascular management of SAEFs compared to open surgery (3).…”

“…While SAEFs are frequently diagnosed intraoperatively during laparotomy, and are occasionally detected pre-operatively with endoscopy, CT angiography is the diagnostic modality of choice (3,7,8,21,22). CT angiography has a relatively high sensitivity (approximately 94%) and specificity (approximately 85%) for the diagnosis of SAEF (23)(24)(25).…”

“…Secondary AEFs (SAEFs) are more common than primary AEFs and generally develop as a result of long-term sequelae of either surgical or endovascular aortic reconstruction, with no significant difference in SAEF incidence between the two approaches (2). Most AEFs develop between the duodenum and the aorta; however, they can occur in almost any section of the GI tract (3).…”