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Online ISSN 1827-1847
Bianchi G., Bocca A., Canale S., Curci R., Franciosi E., Felisi R., De Amicis P., Argenteri A.
Department of Vascular Endovascular Surgery University of Pavia, Lodi Hospital, Lodi, Italy
Aortoenteric fistulae (AEF) is a rare but serious complication of aortic surgery (0.4-4%). The high mortality (28-90%) and morbility (21-60%) of surgical treatment are related to the presenting symptoms (shock and hemodynamic instability). Even if endovascular repair of aortoenteric fistulae (AEFs) is rarely described, it offers an effective short-term treatment, with immediate restoration of hemodynamic stability, and allows late surgical repair. During the last 4 years we observed 4 cases of AEFs. All patients underwent computed tomogtaphy (CT)-scan and two of them gastroscopy. Three out of four patients had an aorto-aortic graft for AAA repair, performed 6 month, 1 and 10 years before (two of them for AAA rupture) and the other one had an aorto-bifemoral graft (performed 4 years before) for aorto-iliac thrombosis. All patients underwent endovascular repair of the AEFs and broad spectrum antibiotic therapy after the procedure. All 4 procedures were immediately successful. 30-day mortality was nil, while recurrent infection rate was 50%. The reinfected patients died within 6 months. Our experience, according to the literature shows that urgent vascular operation and general surgical intervention seem to constitute an independent risk factor for the early development of an AEFs. Literature shows that superiority of endovascular procedures over traditional surgery is statistically significant for short-term mortality (20% vs. 28%) and morbidity (33% vs. 80%) and mean hospital stay (19 vs. 44 days – P<0.01). Medium- and long-term failure of endovascular techniques, when employed as the only therapeutic option, is due to its lack of radicality. In spite of high mortality, open surgical repair of SAEF remains the ”gold standard”. Endovascular repair is a valid alternative in the acute phase with a lower mortality and also represents a “bridge” towards surgical repair. In patients who remain unfit for traditional surgery, long-term broad-spectrum antibiotic therapy and lifelong surveillance are performed.