Management of secondary aorto‐enteric fistulae: a multi‐centre study

Abstract

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.

To maintain qualified privilege and surgeon participation, clinical audit databases must adapt to changing regulations and emerging technologies

“…In this issue of the ANZ Journal of Surgery , the article by Narayanan et al highlights the value of binational surgical audit databases for clinical research and outcome monitoring 1 . This high‐quality research is not possible without binational data from the surgeon‐reported Australasian vascular audit (AVA) 2 .…”