What to do when evidence is lacking--implications on treatment of aortic ulcers, pseudoaneurysms and aorto-enteric fistulae

TY - JOUR

T1 - What to do when evidence is lacking--implications on treatment of aortic ulcers, pseudoaneurysms and aorto-enteric fistulae

AU - Lindblad, B

AU - Holst, J

AU - Kölbel, T

AU - Ivancev, K

AU - Malmö Vascular Centre Group

PY - 2008

Y1 - 2008

N2 - UNLABELLED: Present knowledge on natural history and how to treat penetrating aortic ulcers or different forms of pseudoaneurysms with or without infection is limited as there are only case reports and small series of unusual aortic pathology and its treatment available.MATERIAL: From our centre we collected 65 patients treated with open (n = 15) or endovascular reconstruction (n= 50) during a 20-year period in the abdominal aorta. These patients are presented including a review of contemporary treatment.RESULTS: Endovascular reconstructions seem to reduce morbidity and mortality compared to otherwise extensive open surgery. Even for patients with infectious etiology (mycotic aneurysms, aorto-enteric fistula) endovascular treatment may be a first-hand option bridging to a more elective open repair. However, a large proportion of patients being unfit for further open surgery were solely treated endovascularly and had no major infectious complications in the follow-up. Registers of cases with unusual aortic pathology, not only of those treated but also of those managed conservatively, are needed to define who to treat and if endovascular or open repair should be recommended.CONCLUSION: Endovascular technique is a promising technique for treatment of aortic pseudoaneurysms of different etiologies. We firmly recommend, despite the lack of evidence, that the work up of patients with penetrating aortic ulcers, mycotic or other types of pseudoanerysms as well as aorto-enteric fistulae should enclose both endovascular and open (or combined) treatment modalities. However, our knowledge of the natural history is limited. Therefore, registers of cases with unusual aortic pathology, not only of those treated but also of those managed conservatively, are needed to define who to treat and if endovascular or open repair should be recommended.

AB - UNLABELLED: Present knowledge on natural history and how to treat penetrating aortic ulcers or different forms of pseudoaneurysms with or without infection is limited as there are only case reports and small series of unusual aortic pathology and its treatment available.MATERIAL: From our centre we collected 65 patients treated with open (n = 15) or endovascular reconstruction (n= 50) during a 20-year period in the abdominal aorta. These patients are presented including a review of contemporary treatment.RESULTS: Endovascular reconstructions seem to reduce morbidity and mortality compared to otherwise extensive open surgery. Even for patients with infectious etiology (mycotic aneurysms, aorto-enteric fistula) endovascular treatment may be a first-hand option bridging to a more elective open repair. However, a large proportion of patients being unfit for further open surgery were solely treated endovascularly and had no major infectious complications in the follow-up. Registers of cases with unusual aortic pathology, not only of those treated but also of those managed conservatively, are needed to define who to treat and if endovascular or open repair should be recommended.CONCLUSION: Endovascular technique is a promising technique for treatment of aortic pseudoaneurysms of different etiologies. We firmly recommend, despite the lack of evidence, that the work up of patients with penetrating aortic ulcers, mycotic or other types of pseudoanerysms as well as aorto-enteric fistulae should enclose both endovascular and open (or combined) treatment modalities. However, our knowledge of the natural history is limited. Therefore, registers of cases with unusual aortic pathology, not only of those treated but also of those managed conservatively, are needed to define who to treat and if endovascular or open repair should be recommended.

KW - Aged

KW - Aged, 80 and over

KW - Aneurysm, False/surgery

KW - Aortic Diseases/surgery

KW - Female

KW - Humans

KW - Infections/therapy

KW - Intestinal Fistula/surgery

KW - Male

KW - Middle Aged

KW - Ulcer/surgery

KW - Vascular Fistula/surgery

U2 - 10.1177/145749690809700220

DO - 10.1177/145749690809700220

M3 - SCORING: Review article

C2 - 18575037

VL - 97

SP - 165

EP - 173

JO - SCAND J SURG

JF - SCAND J SURG

SN - 1457-4969

IS - 2

ER -