Open or endovascular repair of aortoenteric fistulas? A multicentre comparative study

Eur J Vasc Endovasc Surg. 2011 May;41(5):625-34. doi: 10.1016/j.ejvs.2010.12.026. Epub 2011 Feb 15.


Objectives: To compare aortoenteric fistula (AEF) outcome after endovascular (EV-AEFR) or open repair (O-AEFR).

Design: Multicentre retrospective comparative study.

Materials/methods: 25 patients with AEF (24 secondary, 23 males, median age 75 years) after aortic surgery (median four years). Preoperative sepsis was evident in 19 cases. Eight patients were managed with EV-AEFR and 17 with O-AEFR.

Results: The two groups were comparable in preoperative characteristics. In-hospital mortality after EV-AEFR was lower compared to O-AEFR (0% and 35%, respectively, p = 0.13). Similarly, morbidity after EV-AEFR was lower compared to O-AEFR (25% and 77%, respectively, p = 0.028). There was a trend for worse recurrence-free, sepsis-free, re-operation-free and AEF-related death-free rates after EV-AEFR, while the early survival advantage of EV-AEFR was lost after two years and the overall long-term survival rates (perioperative mortality included) of the two groups were similar. Preoperative sepsis had no effect on recurrence and sepsis-free rates (p = 0.94 and p = 0.92, respectively), but it was associated with worse two year overall survival (24% vs 50%, p = 0.32). On multivariate analysis, the number of symptoms (two vs one) at presentation was the single predictor of worse re-operation rates, AEF-related and overall survival.

Conclusions: EV-AEFR was associated with no postoperative mortality in this study and can achieve satisfactory short and long-term results, comparable to O-AEFR. Further trials should focus on the role of EV-AEFR in patients at high risk for O-AEFR, due to shock or co-morbidities, or as a bridging procedure.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aorta, Abdominal*
  • Aortic Diseases / diagnosis
  • Aortic Diseases / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Intestinal Fistula / diagnosis
  • Intestinal Fistula / surgery*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stents*
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Vascular Fistula / diagnosis
  • Vascular Fistula / surgery*
  • Vascular Surgical Procedures / methods*