Imperial College London
Alternate

Mr Colin D Bicknell BM MD FRCS

Faculty of Medicine, Department of Surgery & Cancer

Clinical Reader in Vascular Surgery
 
 
 
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Contact

 

+44 (0)20 3312 6428colin.bicknell

 
 
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Location

 

1020Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Kakkos:2016:10.1016/j.ejvs.2016.09.014,
author = {Kakkos, SK and Bicknell, CD and Tsolakis, IA and Bergqvist, D and Hellenic, Co-operative Group on Aortic Surgery},
doi = {10.1016/j.ejvs.2016.09.014},
journal = {European Journal of Vascular and Endovascular Surgery},
pages = {770--786},
title = {Management of secondary aorto-enteric and other abdominal arterio-enteric fistulas: a review and pooled data analysis},
url = {http://dx.doi.org/10.1016/j.ejvs.2016.09.014},
volume = {52},
year = {2016}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - OBJECTIVES: To compare management strategies for secondary abdominal arterio-enteric fistulas (AEFs). METHODS: This study is a review and pooled data analysis. Medline and Scopus databases were searched for studies published between 1999 and 2015. Particular emphasis was given to short- and long-term outcomes in relation to AEF repair type. RESULTS: Two hundred and sixteen publications were retrieved, reporting on 823 patients. In-hospital mortality was 30.7%. Open surgery had higher in-hospital mortality (246/725, 33.9%), than endovascular methods (7/98, 7.1%, p < .001, OR 6.7, 95% CI 3-14.7, including staged endovascular to open surgery, 0/13, 0%). In-hospital mortality after graft removal/extra-anatomical bypass grafting was 31.2% (66/226), graft removal/in situ repair 34% (137/403), primary closure of the arterial defect 62.5% (10/16), and for miscellaneous open procedures 41.3% (33/80), p = .019. Among the subgroups of in situ repair, homografts were associated with a higher mortality than impregnated prosthetic grafts (p = .047). There was no difference in recurrent AEF-free rates between open and endovascular procedures. Extra-anatomical bypass/graft removal and in situ repair had a lower AEF recurrence rate than primary closure and homografts. Late sepsis occurred more often after endovascular surgery (2-year rates 42% vs. 19% for open, p = .001). The early survival benefit of endovascular surgery was blunted during follow-up, although it remained significant (p < .001). Within the in situ repair group, impregnated prosthetic grafts were associated with the worst overall and AEF related mortality free rates and vein grafts with the best. No recurrence, sepsis, or mortality was reported following staged endograft placement to open repair after a mean follow-up of 16.8 months (p = .18, p = .22, and p = .006, respectively, compared with patients in other groups). CONCLUSIONS:
AU  - Kakkos,SK
AU  - Bicknell,CD
AU  - Tsolakis,IA
AU  - Bergqvist,D
AU  - Hellenic,Co-operative Group on Aortic Surgery
DO  - 10.1016/j.ejvs.2016.09.014
EP  - 786
PY  - 2016///
SN  - 1532-2165
SP  - 770
TI  - Management of secondary aorto-enteric and other abdominal arterio-enteric fistulas: a review and pooled data analysis
T2  - European Journal of Vascular and Endovascular Surgery
UR  - http://dx.doi.org/10.1016/j.ejvs.2016.09.014
UR  - http://www.ncbi.nlm.nih.gov/pubmed/27838156
UR  - http://hdl.handle.net/10044/1/42975
VL  - 52
ER  -
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