TY - JOUR
T1 - Secondary Aortoenteric Fistulas Versus Paraprosthetic Erosions
T2 - Is Bleeding Associated with a Worse Outcome?
AU - Valentine, R. James
AU - Timaran, Carlos H.
AU - Modrall, Gregory J.
AU - Smith, Stephen T.
AU - Arko, Frank R.
AU - Clagett, G. Patrick
PY - 2008/12
Y1 - 2008/12
N2 - Background: Direct communication between an aortic prosthesis and the gastrointestinal (GI) tract may present with GI bleeding (aortoenteric fistulas [AEF]) or be incidental to a graft infection (paraprosthetic erosions [PPE]). The purposes of this study were to compare the outcomes of AEF versus PPE and to determine predictors of mortality associated with these lesions. Study Design: Since 1992, 38 patients (23 men, 15 women; mean age 67 years) presented with AEF (n = 16) or PPE (n = 22). Results: After complete graft excision, 26 patients (8 AEF, 18 PPE) underwent in situ revascularization using femoral vein (n = 24) or rifampin-soaked prosthetic graft (n = 2); 12 (8 AEF, 4 PPE) underwent extraanatomic bypass. There was no significant difference in mortality for AEF versus PPE (38% versus 36%). Postoperative complications developed in 25 (66%) patients, including 10 (26%) with GI complications requiring reintervention (5 colon necrosis, 5 duodenal bleed or leak). There were no differences between AEF and PPE in operative transfusions, operative times, GI complications, ICU stay, hospital stay, or final discharge status. Multivariate stepwise logistic regression analysis revealed that GI complications (odds ratio [OR], 52.5; 95% CI, 3.5 to 781; p = 0.004) and age (OR, 1.2; 95% CI, 1.02 to 1.3; p = 0.026) were the only independent predictors of in-hospital mortality. Conclusions: Surgical management of AEF and PPE should be tailored to patient illness and the extent of graft infection. Mortality from both lesions is dependent on patient and technical factors, not on the mode of presentation.
AB - Background: Direct communication between an aortic prosthesis and the gastrointestinal (GI) tract may present with GI bleeding (aortoenteric fistulas [AEF]) or be incidental to a graft infection (paraprosthetic erosions [PPE]). The purposes of this study were to compare the outcomes of AEF versus PPE and to determine predictors of mortality associated with these lesions. Study Design: Since 1992, 38 patients (23 men, 15 women; mean age 67 years) presented with AEF (n = 16) or PPE (n = 22). Results: After complete graft excision, 26 patients (8 AEF, 18 PPE) underwent in situ revascularization using femoral vein (n = 24) or rifampin-soaked prosthetic graft (n = 2); 12 (8 AEF, 4 PPE) underwent extraanatomic bypass. There was no significant difference in mortality for AEF versus PPE (38% versus 36%). Postoperative complications developed in 25 (66%) patients, including 10 (26%) with GI complications requiring reintervention (5 colon necrosis, 5 duodenal bleed or leak). There were no differences between AEF and PPE in operative transfusions, operative times, GI complications, ICU stay, hospital stay, or final discharge status. Multivariate stepwise logistic regression analysis revealed that GI complications (odds ratio [OR], 52.5; 95% CI, 3.5 to 781; p = 0.004) and age (OR, 1.2; 95% CI, 1.02 to 1.3; p = 0.026) were the only independent predictors of in-hospital mortality. Conclusions: Surgical management of AEF and PPE should be tailored to patient illness and the extent of graft infection. Mortality from both lesions is dependent on patient and technical factors, not on the mode of presentation.
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U2 - 10.1016/j.jamcollsurg.2008.08.010
DO - 10.1016/j.jamcollsurg.2008.08.010
M3 - Article
C2 - 19183540
AN - SCOPUS:55949100984
SN - 1072-7515
VL - 207
SP - 922
EP - 927
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 6
ER -