In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas
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In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas. / Janko, Matthew R.; Woo, Karen; Hacker, Robert I.; Baril, Donald; Bath, Jonathan; Smeds, Matthew R.; Kashyap, Vikram S.; Szeberin, Zoltan; Magee, Gregory A.; Elsayed, Ramsey; Wishy, Andrew; St. John, Rebecca; Beck, Adam; Farber, Mark; Motta, Fernando; Zhou, Wei; Lemmon, Gary; Coleman, Dawn; Behrendt, Christian Alexander; Aziz, Faisal; Black, James; Shutze, William; Garrett, H. Edward; De Caridi, Giovanni; Liapis, Christos D.; Geroulakos, George; Kakisis, John; Moulakakis, Konstantinos; Kakkos, Stavros K.; Obara, Hideaki; Wang, Grace; Rhéaume, Pascal; Davila, Victor; Ravin, Reid; DeMartino, Randall; Milner, Ross; Shalhub, Sherene; Jim, Jeffrey; Lee, Jason; Dubuis, Celine; Ricco, Jean Baptiste; Coselli, Joseph; Lemaire, Scott; Fatima, Javairiah; Sanford, Jennifer; Yoshida, Winston; Schermerhorn, Marc L.; Menard, Matthew; Belkin, Michael; Blackwood, Stuart; Conrad, Mark; Wang, Linda; Crofts, Sara; Nixon, Thomas; Wu, Timothy; Chiesa, Roberto; Bose, Saideep; Turner, Jason; Moore, Ryan; Smith, Justin; Ciocca, Rocco; Hsu, Jeffrey; Czerny, Martin; Cullen, Jonathan; Kahlberg, Andrea; Setacci, Carlo; Joh, Jin Hyun; Senneville, Eric; Garrido, Pedro; Sarac, Timur P.; Rizzo, Anthony; Go, Michael R.; Bjorck, Martin; Gavali, Hamid; Wanhainen, Anders; Lawrence, Peter F.; Chung, Jayer.
in: J VASC SURG, Jahrgang 73, Nr. 1, 01.2021, S. 210-221.e1.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas
AU - Janko, Matthew R.
AU - Woo, Karen
AU - Hacker, Robert I.
AU - Baril, Donald
AU - Bath, Jonathan
AU - Smeds, Matthew R.
AU - Kashyap, Vikram S.
AU - Szeberin, Zoltan
AU - Magee, Gregory A.
AU - Elsayed, Ramsey
AU - Wishy, Andrew
AU - St. John, Rebecca
AU - Beck, Adam
AU - Farber, Mark
AU - Motta, Fernando
AU - Zhou, Wei
AU - Lemmon, Gary
AU - Coleman, Dawn
AU - Behrendt, Christian Alexander
AU - Aziz, Faisal
AU - Black, James
AU - Shutze, William
AU - Garrett, H. Edward
AU - De Caridi, Giovanni
AU - Liapis, Christos D.
AU - Geroulakos, George
AU - Kakisis, John
AU - Moulakakis, Konstantinos
AU - Kakkos, Stavros K.
AU - Obara, Hideaki
AU - Wang, Grace
AU - Rhéaume, Pascal
AU - Davila, Victor
AU - Ravin, Reid
AU - DeMartino, Randall
AU - Milner, Ross
AU - Shalhub, Sherene
AU - Jim, Jeffrey
AU - Lee, Jason
AU - Dubuis, Celine
AU - Ricco, Jean Baptiste
AU - Coselli, Joseph
AU - Lemaire, Scott
AU - Fatima, Javairiah
AU - Sanford, Jennifer
AU - Yoshida, Winston
AU - Schermerhorn, Marc L.
AU - Menard, Matthew
AU - Belkin, Michael
AU - Blackwood, Stuart
AU - Conrad, Mark
AU - Wang, Linda
AU - Crofts, Sara
AU - Nixon, Thomas
AU - Wu, Timothy
AU - Chiesa, Roberto
AU - Bose, Saideep
AU - Turner, Jason
AU - Moore, Ryan
AU - Smith, Justin
AU - Ciocca, Rocco
AU - Hsu, Jeffrey
AU - Czerny, Martin
AU - Cullen, Jonathan
AU - Kahlberg, Andrea
AU - Setacci, Carlo
AU - Joh, Jin Hyun
AU - Senneville, Eric
AU - Garrido, Pedro
AU - Sarac, Timur P.
AU - Rizzo, Anthony
AU - Go, Michael R.
AU - Bjorck, Martin
AU - Gavali, Hamid
AU - Wanhainen, Anders
AU - Lawrence, Peter F.
AU - Chung, Jayer
N1 - Publisher Copyright: © 2020 Society for Vascular Surgery
PY - 2021/1
Y1 - 2021/1
N2 - Objective: The optimal revascularization modality in secondary aortoenteric fistula (SAEF) remains unclear in the literature. The purpose of this investigation was to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients with SAEF. Methods: A retrospective, multi-institutional study of SAEF from 2002 to 2014 was performed using a standardized database. Baseline demographics, comorbidities, and operative and postoperative variables were recorded. The primary outcome was long-term mortality. Descriptive statistics, Kaplan-Meier survival analysis, and univariate and multivariate analyses were performed. Results: During the study period, 182 patients at 34 institutions from 11 countries presented with SAEF (median age, 72 years; 79% male). The initial aortic procedures that resulted in SAEF were 138 surgical grafts (76%) and 42 endografts (23%), with 2 unknown; 102 of the SAEFs (56%) underwent complete excision of infected aortic graft material, followed by in situ (in-line) bypass (ISB), including antibiotic-soaked prosthetic graft (53), autogenous femoral vein (neoaortoiliac surgery; 17), cryopreserved allograft (28), and untreated prosthetic grafts (4). There were 80 patients (44%) who underwent extra-anatomic bypass (EAB) with infected graft excision. Overall median Kaplan-Meier estimated survival was 319 days (interquartile range, 20-2410 days). Stratified by EAB vs ISB, there was no significant difference in Kaplan-Meier estimated survival (P =.82). In comparing EAB vs ISB, EAB patients were older (74 vs 70 years; P =.01), had less operative hemorrhage (1200 mL vs 2000 mL; P =.04), were more likely to initiate dialysis within 30 days postoperatively (15% vs 5%; P =.02), and were less likely to experience aorta-related hemorrhage within 30 days postoperatively (3% aortic stump dehiscence vs 11% anastomotic rupture; P =.03). There were otherwise no significant differences in presentation, comorbidities, and intraoperative or postoperative variables. Multivariable Cox regression showed that the duration of antibiotic use (hazard ratio, 0.92; 95% confidence interval, 0.86-0.98; P =.01) and rifampin use at time of discharge (hazard ratio, 0.20; 95% confidence interval, 0.05-0.86; P =.03) independently decreased mortality. Conclusions: These data suggest that ISB does not offer a survival advantage compared with EAB and does not decrease the risk of postoperative aorta-related hemorrhage. After repair, <50% of SAEF patients survive 10 months. Each week of antibiotic use decreases mortality by 8%. Further study with risk modeling is imperative for this population.
AB - Objective: The optimal revascularization modality in secondary aortoenteric fistula (SAEF) remains unclear in the literature. The purpose of this investigation was to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients with SAEF. Methods: A retrospective, multi-institutional study of SAEF from 2002 to 2014 was performed using a standardized database. Baseline demographics, comorbidities, and operative and postoperative variables were recorded. The primary outcome was long-term mortality. Descriptive statistics, Kaplan-Meier survival analysis, and univariate and multivariate analyses were performed. Results: During the study period, 182 patients at 34 institutions from 11 countries presented with SAEF (median age, 72 years; 79% male). The initial aortic procedures that resulted in SAEF were 138 surgical grafts (76%) and 42 endografts (23%), with 2 unknown; 102 of the SAEFs (56%) underwent complete excision of infected aortic graft material, followed by in situ (in-line) bypass (ISB), including antibiotic-soaked prosthetic graft (53), autogenous femoral vein (neoaortoiliac surgery; 17), cryopreserved allograft (28), and untreated prosthetic grafts (4). There were 80 patients (44%) who underwent extra-anatomic bypass (EAB) with infected graft excision. Overall median Kaplan-Meier estimated survival was 319 days (interquartile range, 20-2410 days). Stratified by EAB vs ISB, there was no significant difference in Kaplan-Meier estimated survival (P =.82). In comparing EAB vs ISB, EAB patients were older (74 vs 70 years; P =.01), had less operative hemorrhage (1200 mL vs 2000 mL; P =.04), were more likely to initiate dialysis within 30 days postoperatively (15% vs 5%; P =.02), and were less likely to experience aorta-related hemorrhage within 30 days postoperatively (3% aortic stump dehiscence vs 11% anastomotic rupture; P =.03). There were otherwise no significant differences in presentation, comorbidities, and intraoperative or postoperative variables. Multivariable Cox regression showed that the duration of antibiotic use (hazard ratio, 0.92; 95% confidence interval, 0.86-0.98; P =.01) and rifampin use at time of discharge (hazard ratio, 0.20; 95% confidence interval, 0.05-0.86; P =.03) independently decreased mortality. Conclusions: These data suggest that ISB does not offer a survival advantage compared with EAB and does not decrease the risk of postoperative aorta-related hemorrhage. After repair, <50% of SAEF patients survive 10 months. Each week of antibiotic use decreases mortality by 8%. Further study with risk modeling is imperative for this population.
KW - Aorta
KW - Aortoenteric fistula
UR - http://www.scopus.com/inward/record.url?scp=85090120093&partnerID=8YFLogxK
U2 - 10.1016/j.jvs.2020.04.515
DO - 10.1016/j.jvs.2020.04.515
M3 - SCORING: Journal article
C2 - 32445832
AN - SCOPUS:85090120093
VL - 73
SP - 210-221.e1
JO - J VASC SURG
JF - J VASC SURG
SN - 0741-5214
IS - 1
ER -