Endovascular treatment of aortoesophageal and aortobronchial fistulae

• Published in: Journal of vascular surgery 2010-05, Vol.51 (5), p.1195-1202
• Main Authors: Chiesa, Roberto, MD, Melissano, Germano, MD, Marone, Enrico M., MD, Kahlberg, Andrea, MD, Marrocco-Trischitta, Massimiliano M., MD, PhD, Tshomba, Yamume, MD
• Format: Article
• Language: English
• Subjects: Academic Medical Centers; Aged; Aged, 80 and over; Angioplasty - methods; Angioplasty - mortality; Aortic Diseases - diagnosis; Aortic Diseases - mortality; Aortic Diseases - surgery; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - methods; Blood Vessel Prosthesis Implantation - mortality; Bronchial Fistula - diagnosis; Bronchial Fistula - mortality; Bronchial Fistula - surgery; Cross-Sectional Studies; Esophageal Diseases - diagnosis; Esophageal Diseases - mortality; Esophageal Diseases - surgery; Female; Hospitals, University; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Postoperative Complications - mortality; Prognosis; Prosthesis Failure; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Surgery; Surveys and Questionnaires; Survival Analysis; Treatment Outcome; Vascular Fistula - diagnosis; Vascular Fistula - mortality; Vascular Fistula - surgery
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2009.10.130

Background Even when promptly recognized and treated, aortoesophageal (AEF) and aortobronchial (ABF) fistulae are highly lethal conditions. Open surgical repair also carries a high risk of mortality and morbidity. Several alternative strategies have been recently reported in the literature including thoracic endovascular aortic repair (TEVAR). However, relatively little is known about results of TEVAR for AEF and ABF due to their rarity and the lack of large surveys. Methods A voluntary national survey was conducted among Italian universities and hospital centers with an endovascular program. Questionnaires were distributed by e-mail to participating centers and aimed to evaluate the results of endovascular repair of established AEF or ABF. Results Seventeen centers agreed to participate and provided data on their patients. Between 1998 and 2008, a total of 1138 patients were treated with TEVAR. In 25 patients (2.2%), the indication to treatment was an AEF and/or an ABF. In 10 of these cases (40%), an associated open surgical procedure was also performed. Thirty-day mortality rate of AEF/ABF endovascular repair was 28% (7 cases). No cases of paraplegia or stroke were observed. Mean follow-up was 22.6 months (range, 1-62). Actuarial survival at 2 years was 55%. Among the 18 initial survivors, five patients (28%) underwent reintervention due to late TEVAR failure. Conclusions Stent grafting for AEF and ABF represents a viable option in emergent and urgent settings. However, further esophageal or bronchial repair is necessary in most cases. Despite less invasive attempts, mortality associated with these conditions remains very high.