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

摘要: Objectives To compare management strategies for secondary abdominal arterio-enteric fistulas (AEFs). Methods This study is a review and pooled data analysis. Medline Scopus databases were searched studies published between 1999 2015. Particular emphasis was given to short- long-term outcomes in relation AEF repair type. Results Two hundred sixteen publications retrieved, reporting on 823 patients. In-hospital mortality 30.7%. Open surgery had higher in-hospital (246/725, 33.9%), than endovascular methods (7/98, 7.1%, p < .001, OR 6.7, 95% CI 3–14.7, including staged open surgery, 0/13, 0%). after graft removal/extra-anatomical bypass grafting 31.2% (66/226), removal/in situ 34% (137/403), primary closure of the arterial defect 62.5% (10/16), miscellaneous procedures 41.3% (33/80), p = .019. Among subgroups repair, homografts associated with impregnated prosthetic grafts (p = .047). There no difference recurrent AEF-free rates procedures. Extra-anatomical bypass/graft removal lower recurrence rate homografts. Late sepsis occurred more often (2-year 42% vs. 19% open, p = .001). The early survival benefit blunted during follow-up, although it remained significant (p < .001). Within group, worst overall related free vein best. No recurrence, sepsis, or reported following endograft placement mean follow-up 16.8 months (p = .18, p = .22, p = .006, respectively, compared patients other groups). Conclusions Endovascular where appropriate, better AEFs. Most this lost implying that approach conversion may achieve best results selected