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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, Vol. 73, No. 1, 01.2021, p. 210-221.e1.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Janko, MR, Woo, K, Hacker, RI, Baril, D, Bath, J, Smeds, MR, Kashyap, VS, Szeberin, Z, Magee, GA, Elsayed, R, Wishy, A, St. John, R, Beck, A, Farber, M, Motta, F, Zhou, W, Lemmon, G, Coleman, D, Behrendt, CA, Aziz, F, Black, J, Shutze, W, Garrett, HE, De Caridi, G, Liapis, CD, Geroulakos, G, Kakisis, J, Moulakakis, K, Kakkos, SK, Obara, H, Wang, G, Rhéaume, P, Davila, V, Ravin, R, DeMartino, R, Milner, R, Shalhub, S, Jim, J, Lee, J, Dubuis, C, Ricco, JB, Coselli, J, Lemaire, S, Fatima, J, Sanford, J, Yoshida, W, Schermerhorn, ML, Menard, M, Belkin, M, Blackwood, S, Conrad, M, Wang, L, Crofts, S, Nixon, T, Wu, T, Chiesa, R, Bose, S, Turner, J, Moore, R, Smith, J, Ciocca, R, Hsu, J, Czerny, M, Cullen, J, Kahlberg, A, Setacci, C, Joh, JH, Senneville, E, Garrido, P, Sarac, TP, Rizzo, A, Go, MR, Bjorck, M, Gavali, H, Wanhainen, A, Lawrence, PF & Chung, J 2021, 'In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas', J VASC SURG, vol. 73, no. 1, pp. 210-221.e1. https://doi.org/10.1016/j.jvs.2020.04.515

APA

Janko, M. R., Woo, K., Hacker, R. I., Baril, D., Bath, J., Smeds, M. R., Kashyap, V. S., Szeberin, Z., Magee, G. A., Elsayed, R., Wishy, A., St. John, R., Beck, A., Farber, M., Motta, F., Zhou, W., Lemmon, G., Coleman, D., Behrendt, C. A., ... Chung, J. (2021). In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas. J VASC SURG, 73(1), 210-221.e1. https://doi.org/10.1016/j.jvs.2020.04.515

Vancouver

Janko MR, Woo K, Hacker RI, Baril D, Bath J, Smeds MR et al. In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas. J VASC SURG. 2021 Jan;73(1):210-221.e1. https://doi.org/10.1016/j.jvs.2020.04.515

Bibtex

@article{05e0e66c56564839815c3f9d07b3231e,
title = "In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas",
abstract = "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.",
keywords = "Aorta, Aortoenteric fistula",
author = "Janko, {Matthew R.} and Karen Woo and Hacker, {Robert I.} and Donald Baril and Jonathan Bath and Smeds, {Matthew R.} and Kashyap, {Vikram S.} and Zoltan Szeberin and Magee, {Gregory A.} and Ramsey Elsayed and Andrew Wishy and {St. John}, Rebecca and Adam Beck and Mark Farber and Fernando Motta and Wei Zhou and Gary Lemmon and Dawn Coleman and Behrendt, {Christian Alexander} and Faisal Aziz and James Black and William Shutze and Garrett, {H. Edward} and {De Caridi}, Giovanni and Liapis, {Christos D.} and George Geroulakos and John Kakisis and Konstantinos Moulakakis and Kakkos, {Stavros K.} and Hideaki Obara and Grace Wang and Pascal Rh{\'e}aume and Victor Davila and Reid Ravin and Randall DeMartino and Ross Milner and Sherene Shalhub and Jeffrey Jim and Jason Lee and Celine Dubuis and Ricco, {Jean Baptiste} and Joseph Coselli and Scott Lemaire and Javairiah Fatima and Jennifer Sanford and Winston Yoshida and Schermerhorn, {Marc L.} and Matthew Menard and Michael Belkin and Stuart Blackwood and Mark Conrad and Linda Wang and Sara Crofts and Thomas Nixon and Timothy Wu and Roberto Chiesa and Saideep Bose and Jason Turner and Ryan Moore and Justin Smith and Rocco Ciocca and Jeffrey Hsu and Martin Czerny and Jonathan Cullen and Andrea Kahlberg and Carlo Setacci and Joh, {Jin Hyun} and Eric Senneville and Pedro Garrido and Sarac, {Timur P.} and Anthony Rizzo and Go, {Michael R.} and Martin Bjorck and Hamid Gavali and Anders Wanhainen and Lawrence, {Peter F.} and Jayer Chung",
note = "Publisher Copyright: {\textcopyright} 2020 Society for Vascular Surgery",
year = "2021",
month = jan,
doi = "10.1016/j.jvs.2020.04.515",
language = "English",
volume = "73",
pages = "210--221.e1",
journal = "J VASC SURG",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "1",

}

RIS

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 -