In-situ Bypass and Extra-anatomic Bypass Procedures Result in Similar Survival in Patients with Secondary Aorto-Enteric Fistulae.
Matthew R. Janko
(1)
,
Karen Woo
(2)
,
Robert I. Hacker
,
Donald Baril
(2)
,
Jonathan Bath
(3)
,
Matthew R. Smeds
,
Vikram S. Kashyap
(1)
,
Zoltan Szeberin
(4)
,
Gregory Magee
(5)
,
Ramsey Elsayed
(5)
,
Andrew Wishy
(6)
,
Rebecca St John
(7)
,
Adam Beck
(7)
,
Mark Farber
(8)
,
Fernando Motta
(8)
,
Wei Zhou
(9)
,
Gary Lemmon
,
Dawn Coleman
(10)
,
Christian-Alexander Behrendt
(11)
,
Faisal Aziz
(12)
,
James Black
(13)
,
William Shutze
,
H. Edward Garrett
,
Giovanni de Caridi
(14)
,
Christos Liapis
(15)
,
George Geroulakos
(16)
,
John Kakisis
(15)
,
Konstantinos Moulakakis
(15)
,
Stavros Kakkos
(17)
,
Hideaki Obara
(18)
,
Grace Wang
(19)
,
Pascal Rhéaume
(20)
,
Victor Davila
(21)
,
Reid Ravin
,
Randall Demartino
(22)
,
Ross Milner
(23)
,
Sherene Shalhub
(24)
,
Jeffrey Jim
(25)
,
Jason Lee
,
Celine Dubuis
,
Joseph Coselli
,
Scott Lemaire
,
Javairiah Fatima
,
Jennifer Sanford
,
Winston Yoshida
,
Marc Schermerhorn
,
Matthew Menard
(26)
,
Michael Belkin
(26)
,
Stuart Blackwood
(26)
,
Mark Conrad
(27)
,
Linda Wang
(27)
,
Sara Crofts
(27)
,
Thomas Nixon
(27)
,
Timothy Wu
(28)
,
Roberto Chiesa
(29)
,
Saideep Bose
(1)
,
Jason Turner
(1)
,
Ryan Moore
(30)
,
Justin Smith
(31)
,
Rocco Ciocca
(1)
,
Jeffrey Hsu
(32)
,
Martin Czerny
(33)
,
Jonathan Cullen
,
Andrea Kahlberg
(34)
,
Carlo Setacci
(35)
,
Jin Hyun Joh
(36)
,
Eric Senneville
(37)
,
Pedro Garrido
(38)
,
Timur Sarac
(39)
,
Anthony Rizzo
(39)
,
Michael Go
(39)
,
Martin Bjorck
(40)
,
Hamid Gavali
(40)
,
Anders Wanhainen
(40)
,
Peter F. Lawrence
(2)
,
Jayer Chung
1
Case Western Reserve University [Cleveland]
2 UCLA - University of California [Los Angeles]
3 Mizzou - University of Missouri [Columbia]
4 Semmelweis University of Medicine [Budapest]
5 USC - University of Southern California
6 UC Davis - University of California [Davis]
7 UAB - University of Alabama at Birmingham [ Birmingham]
8 UNC - University of North Carolina [Chapel Hill]
9 University of Arizona
10 University of Michigan [Ann Arbor]
11 UKE - Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg]
12 Medical University of Graz = Medizinische Universität Graz
13 Johns Hopkins University School of Medicine [Baltimore]
14 UniMe - Università degli Studi di Messina = University of Messina
15 University of Athens Medical School [Athens]
16 “Attikon” University Hospital
17 University of Patras
18 Keio University [Tokyo]
19 NCKU - National Cheng Kung University
20 University of British Columbia [Vancouver]
21 Mayo Clinic
22 Mayo Clinic [Rochester]
23 University of Chicago
24 University of Washington [Seattle]
25 Washington University School of Medicine [Saint Louis, MO]
26 Brigham and Women's Hospital [Boston]
27 Massachusetts General Hospital [Boston]
28 RWJMS - Robert Wood Johnson Medical School [Piscataway, NJ]
29 UniSR - Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie]
30 University of Delaware [Newark]
31 Public Health England [London]
32 Kaiser Permanente
33 Albert-Ludwigs-Universität Freiburg = University of Freiburg
34 San Raffaele Scientific Institute
35 UNISI - Università degli Studi di Siena = University of Siena
36 KHU - Kyung Hee University
37 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
38 UGR - Universidad de Granada = University of Granada
39 OSU - The Ohio State University [Columbus]
40 Uppsala Universitet [Uppsala]
2 UCLA - University of California [Los Angeles]
3 Mizzou - University of Missouri [Columbia]
4 Semmelweis University of Medicine [Budapest]
5 USC - University of Southern California
6 UC Davis - University of California [Davis]
7 UAB - University of Alabama at Birmingham [ Birmingham]
8 UNC - University of North Carolina [Chapel Hill]
9 University of Arizona
10 University of Michigan [Ann Arbor]
11 UKE - Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg]
12 Medical University of Graz = Medizinische Universität Graz
13 Johns Hopkins University School of Medicine [Baltimore]
14 UniMe - Università degli Studi di Messina = University of Messina
15 University of Athens Medical School [Athens]
16 “Attikon” University Hospital
17 University of Patras
18 Keio University [Tokyo]
19 NCKU - National Cheng Kung University
20 University of British Columbia [Vancouver]
21 Mayo Clinic
22 Mayo Clinic [Rochester]
23 University of Chicago
24 University of Washington [Seattle]
25 Washington University School of Medicine [Saint Louis, MO]
26 Brigham and Women's Hospital [Boston]
27 Massachusetts General Hospital [Boston]
28 RWJMS - Robert Wood Johnson Medical School [Piscataway, NJ]
29 UniSR - Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie]
30 University of Delaware [Newark]
31 Public Health England [London]
32 Kaiser Permanente
33 Albert-Ludwigs-Universität Freiburg = University of Freiburg
34 San Raffaele Scientific Institute
35 UNISI - Università degli Studi di Siena = University of Siena
36 KHU - Kyung Hee University
37 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
38 UGR - Universidad de Granada = University of Granada
39 OSU - The Ohio State University [Columbus]
40 Uppsala Universitet [Uppsala]
Robert I. Hacker
- Fonction : Auteur
Matthew R. Smeds
- Fonction : Auteur
Gary Lemmon
- Fonction : Auteur
William Shutze
- Fonction : Auteur
H. Edward Garrett
- Fonction : Auteur
Reid Ravin
- Fonction : Auteur
Jason Lee
- Fonction : Auteur
Celine Dubuis
- Fonction : Auteur
Joseph Coselli
- Fonction : Auteur
Scott Lemaire
- Fonction : Auteur
Javairiah Fatima
- Fonction : Auteur
Jennifer Sanford
- Fonction : Auteur
Winston Yoshida
- Fonction : Auteur
Marc Schermerhorn
- Fonction : Auteur
Jonathan Cullen
- Fonction : Auteur
Jayer Chung
- Fonction : Auteur
Résumé
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.