Abstract
BackgroundSecondary aorto-enteric fistulae (SAEF) are a rare, complex and life-threatening complication following aortic repair. Traditional treatment strategy has been with open aortic repair (OAR), with emergence of endovascular repair (EVAR) as a potentially viable initial treatment option. Controversy exists over optimal immediate and long-term management. MethodsAn observational, retrospective, multi-institutional study of patients who had been treated for SAEF between 2003 and 2020 was performed using a standardized database. Baseline characteristics, presenting features, microbiological, operative and post-operative variables were recorded. The primary outcome was short and mid-term mortality. Descriptive statistics, Kaplan-Meier, Cox age-adjusted survival analysis and binomial regression analysis were performed. ResultsThere were 47 patients treated for SAEF identified, with a median (range) age at presentation of 74 (48-93) and 7 were females. Initially, there were 24 (51%) treated with OAR, 15 (32%) with EVAR and 8 (17%) non-operatively. The 30-day and 1-year mortality for all cases that underwent intervention was 21% and 46% respectively. Age-adjusted survival analysis revealed no statistically significant difference in mortality in the EVAR-first group compared to the OAR-first group, HR 0.99 (95% CI 0.94-1.03, P = 0.61). ConclusionIn this study there was no difference in all-cause survival in patients who had OAR or EVAR as first line treatment for SAEF. In the acute setting, alongside broad-spectrum antimicrobial therapy, EVAR can be considered as an initial treatment for patients with SAEF, as a primary treatment or a bridge to definitive OAR.