In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas

Standard

In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas. / Janko, Matthew R; Woo, Karen; Hacker, Robert I; Baril, Donald; Bath, Jonathan; Smeds, Matthew R; Kashyap, Vikram S; Szeberin, Zoltan; Magee, Gregory; Elsayed, Ramsey; Wishy, Andrew; St John, Rebecca; Beck, Adam; Farber, Mark; Motta, Fernando; Zhou, Wei; Lemmon, Gary; Coleman, Dawn; Behrendt, Christian-Alexander; Aziz, Faisal; Black, James; Shutze, William; Garrett, H Edward; de Caridi, Giovanni; Liapis, Christos; Kakkos, Stavros; Obara, Hideaki; Wang, Grace; Rhéaume, Pascal; Davila, Victor; Ravin, Reid; DeMartino, Randall; Milner, Ross; Shalhub, Sherene; Jim, Jeffrey; Lee, Jason; Dubuis, Celine; Ricco, Jean-Baptiste; Coselli, Joseph; Lemaire, Scott; Fatima, Jahvairiah; Sanford, Jennifer; Yoshida, Winston; Schermerhorn, Marc; Menard, Matthew; Belkin, Michael; Blackwood, Stuart; Conrad, Mark; Wang, Linda; Crofts, Sara; Nixon, Thomas; Wu, Timothy; Chiesa, Roberto; Bose, Saideep; Turner, Jason; Moore, Ryan; Smith, Justin; Ciocca, Rocco; Hsu, Jeffrey; Czerny, Martin; Cullen, Jonathan; Kahlberg, Andrea; Setacci, Carlo; Joh, Jin Hyun; Senneville, Eric; Garrido, Pedro; Sarac, Timur; Rizzo, Anthony; Go, Michael; Bjorck, Martin; Gavali, Hamid; Wanhainen, Anders; Lawrence, Peter F; Chung, Jayer.

in: J VASC SURG, Jahrgang 73, Nr. 1, 01.2021, S. 210-221.e1.

Publikationen: SCORING: Beitrag in Fachzeitschrift/ZeitungSCORING: ZeitschriftenaufsätzeForschungBegutachtung

Harvard

Janko, MR, Woo, K, Hacker, RI, Baril, D, Bath, J, Smeds, MR, Kashyap, VS, Szeberin, Z, Magee, G, Elsayed, R, Wishy, A, St John, R, Beck, A, Farber, M, Motta, F, Zhou, W, Lemmon, G, Coleman, D, Behrendt, C-A, Aziz, F, Black, J, Shutze, W, Garrett, HE, de Caridi, G, Liapis, C, Kakkos, S, Obara, H, Wang, G, Rhéaume, P, Davila, V, Ravin, R, DeMartino, R, Milner, R, Shalhub, S, Jim, J, Lee, J, Dubuis, C, Ricco, J-B, Coselli, J, Lemaire, S, Fatima, J, Sanford, J, Yoshida, W, Schermerhorn, M, Menard, M, Belkin, M, Blackwood, S, Conrad, M, Wang, L, Crofts, S, Nixon, T, Wu, T, Chiesa, R, Bose, S, Turner, J, Moore, R, Smith, J, Ciocca, R, Hsu, J, Czerny, M, Cullen, J, Kahlberg, A, Setacci, C, Joh, JH, Senneville, E, Garrido, P, Sarac, T, Rizzo, A, Go, M, Bjorck, M, Gavali, H, Wanhainen, A, Lawrence, PF & Chung, J 2021, 'In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas', J VASC SURG, Jg. 73, Nr. 1, S. 210-221.e1. https://doi.org/10.1016/j.jvs.2020.04.515

APA

Janko, M. R., Woo, K., Hacker, R. I., Baril, D., Bath, J., Smeds, M. R., Kashyap, V. S., Szeberin, Z., Magee, G., Elsayed, R., Wishy, A., St John, R., Beck, A., Farber, M., Motta, F., Zhou, W., Lemmon, G., Coleman, D., Behrendt, C-A., ... Chung, J. (2021). In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas. J VASC SURG, 73(1), 210-221.e1. https://doi.org/10.1016/j.jvs.2020.04.515

Vancouver

Bibtex

@article{60d3ab75e8eb4d0daa0e49d0c80a8708,
title = "In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas",
abstract = "OBJECTIVE: The optimal revascularization modality in secondary abdominal aorto-enteric 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 2002-2014 was performed using a standardized database. Baseline demographics, comorbidities, 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: 182 patients at 34 institutions from 11 countries presented with SAEF during the study period (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 SAEF (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 (NAIS) (17), cryopreserved allograft (28), and untreated prosthetic grafts (4). 80 patients (44%) underwent extra-anatomic bypass (EAB) with infected graft excision. Overall median Kaplan-Meier (KM) estimated survival was 319 days (IQR 20, 2410) days. When stratified by EAB versus ISB, there was no significant difference in KM estimated survival (p=0.82). Comparing EAB versus ISB, EAB patients were older (age 74 vs. 70; p=0.01), had less operative hemorrhage (1200mL vs. 2000mL; p=0.04), were more likely to initiate dialysis within 30 days postoperatively (15% vs. 5%, p=0.02), and were less likely to experience aortic-related hemorrhage within 30 days postoperatively (3% aortic stump dehiscence vs. 11% anastomotic rupture, p=0.03). There were otherwise no significant differences in presentation, comorbidities, intra-operative or postoperative variables. Multivariable Cox regression showed the duration of antibiotic use (HR 0.92, 95% CI 0.86-0.98; p = 0.01) and rifampin use at time of discharge (HR 0.20, 0.05-0.86, p = 0.03) independently decreased mortality.CONCLUSIONS: These data suggest ISB does not offer a survival advantage compared to EAB and does not decrease the risk of postoperative aortic-related hemorrhage. Less than 50% of SAEF patients survive ten months after repair. Each week of antibiotic use decreases mortality by 8%. Further study with risk modeling are imperative for this population.",
keywords = "Aorta, Aortoenteric fistula",
author = "Janko, {Matthew R} and Karen Woo and Hacker, {Robert I} and Donald Baril and Jonathan Bath and Smeds, {Matthew R} and Kashyap, {Vikram S} and Zoltan Szeberin and Gregory Magee and Ramsey Elsayed and Andrew Wishy and {St John}, Rebecca and Adam Beck and Mark Farber and Fernando Motta and Wei Zhou and Gary Lemmon and Dawn Coleman and Christian-Alexander Behrendt and Faisal Aziz and James Black and William Shutze and Garrett, {H Edward} and {de Caridi}, Giovanni and Christos Liapis and Stavros Kakkos and Hideaki Obara and Grace Wang and Pascal Rh{\'e}aume and Victor Davila and Reid Ravin and Randall DeMartino and Ross Milner and Sherene Shalhub and Jeffrey Jim and Jason Lee and Celine Dubuis and Jean-Baptiste Ricco and Joseph Coselli and Scott Lemaire and Jahvairiah Fatima and Jennifer Sanford and Winston Yoshida and Marc Schermerhorn and Matthew Menard and Michael Belkin and Stuart Blackwood and Mark Conrad and Linda Wang and Sara Crofts and Thomas Nixon and Timothy Wu and Roberto Chiesa and Saideep Bose and Jason Turner and Ryan Moore and Justin Smith and Rocco Ciocca and Jeffrey Hsu and Martin Czerny and Jonathan Cullen and Andrea Kahlberg and Carlo Setacci and Joh, {Jin Hyun} and Eric Senneville and Pedro Garrido and Timur Sarac and Anthony Rizzo and Michael Go and Martin Bjorck and Hamid Gavali and Anders Wanhainen and Lawrence, {Peter F} and Jayer Chung",
note = "Copyright {\textcopyright} 2020. Published by Elsevier Inc.",
year = "2021",
month = jan,
doi = "10.1016/j.jvs.2020.04.515",
language = "English",
volume = "73",
pages = "210--221.e1",
journal = "J VASC SURG",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "1",

}

RIS

TY - JOUR

T1 - In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas

AU - Janko, Matthew R

AU - Woo, Karen

AU - Hacker, Robert I

AU - Baril, Donald

AU - Bath, Jonathan

AU - Smeds, Matthew R

AU - Kashyap, Vikram S

AU - Szeberin, Zoltan

AU - Magee, Gregory

AU - Elsayed, Ramsey

AU - Wishy, Andrew

AU - St John, Rebecca

AU - Beck, Adam

AU - Farber, Mark

AU - Motta, Fernando

AU - Zhou, Wei

AU - Lemmon, Gary

AU - Coleman, Dawn

AU - Behrendt, Christian-Alexander

AU - Aziz, Faisal

AU - Black, James

AU - Shutze, William

AU - Garrett, H Edward

AU - de Caridi, Giovanni

AU - Liapis, Christos

AU - Kakkos, Stavros

AU - Obara, Hideaki

AU - Wang, Grace

AU - Rhéaume, Pascal

AU - Davila, Victor

AU - Ravin, Reid

AU - DeMartino, Randall

AU - Milner, Ross

AU - Shalhub, Sherene

AU - Jim, Jeffrey

AU - Lee, Jason

AU - Dubuis, Celine

AU - Ricco, Jean-Baptiste

AU - Coselli, Joseph

AU - Lemaire, Scott

AU - Fatima, Jahvairiah

AU - Sanford, Jennifer

AU - Yoshida, Winston

AU - Schermerhorn, Marc

AU - Menard, Matthew

AU - Belkin, Michael

AU - Blackwood, Stuart

AU - Conrad, Mark

AU - Wang, Linda

AU - Crofts, Sara

AU - Nixon, Thomas

AU - Wu, Timothy

AU - Chiesa, Roberto

AU - Bose, Saideep

AU - Turner, Jason

AU - Moore, Ryan

AU - Smith, Justin

AU - Ciocca, Rocco

AU - Hsu, Jeffrey

AU - Czerny, Martin

AU - Cullen, Jonathan

AU - Kahlberg, Andrea

AU - Setacci, Carlo

AU - Joh, Jin Hyun

AU - Senneville, Eric

AU - Garrido, Pedro

AU - Sarac, Timur

AU - Rizzo, Anthony

AU - Go, Michael

AU - Bjorck, Martin

AU - Gavali, Hamid

AU - Wanhainen, Anders

AU - Lawrence, Peter F

AU - Chung, Jayer

N1 - Copyright © 2020. Published by Elsevier Inc.

PY - 2021/1

Y1 - 2021/1

N2 - OBJECTIVE: The optimal revascularization modality in secondary abdominal aorto-enteric 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 2002-2014 was performed using a standardized database. Baseline demographics, comorbidities, 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: 182 patients at 34 institutions from 11 countries presented with SAEF during the study period (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 SAEF (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 (NAIS) (17), cryopreserved allograft (28), and untreated prosthetic grafts (4). 80 patients (44%) underwent extra-anatomic bypass (EAB) with infected graft excision. Overall median Kaplan-Meier (KM) estimated survival was 319 days (IQR 20, 2410) days. When stratified by EAB versus ISB, there was no significant difference in KM estimated survival (p=0.82). Comparing EAB versus ISB, EAB patients were older (age 74 vs. 70; p=0.01), had less operative hemorrhage (1200mL vs. 2000mL; p=0.04), were more likely to initiate dialysis within 30 days postoperatively (15% vs. 5%, p=0.02), and were less likely to experience aortic-related hemorrhage within 30 days postoperatively (3% aortic stump dehiscence vs. 11% anastomotic rupture, p=0.03). There were otherwise no significant differences in presentation, comorbidities, intra-operative or postoperative variables. Multivariable Cox regression showed the duration of antibiotic use (HR 0.92, 95% CI 0.86-0.98; p = 0.01) and rifampin use at time of discharge (HR 0.20, 0.05-0.86, p = 0.03) independently decreased mortality.CONCLUSIONS: These data suggest ISB does not offer a survival advantage compared to EAB and does not decrease the risk of postoperative aortic-related hemorrhage. Less than 50% of SAEF patients survive ten months after repair. Each week of antibiotic use decreases mortality by 8%. Further study with risk modeling are imperative for this population.

AB - OBJECTIVE: The optimal revascularization modality in secondary abdominal aorto-enteric 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 2002-2014 was performed using a standardized database. Baseline demographics, comorbidities, 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: 182 patients at 34 institutions from 11 countries presented with SAEF during the study period (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 SAEF (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 (NAIS) (17), cryopreserved allograft (28), and untreated prosthetic grafts (4). 80 patients (44%) underwent extra-anatomic bypass (EAB) with infected graft excision. Overall median Kaplan-Meier (KM) estimated survival was 319 days (IQR 20, 2410) days. When stratified by EAB versus ISB, there was no significant difference in KM estimated survival (p=0.82). Comparing EAB versus ISB, EAB patients were older (age 74 vs. 70; p=0.01), had less operative hemorrhage (1200mL vs. 2000mL; p=0.04), were more likely to initiate dialysis within 30 days postoperatively (15% vs. 5%, p=0.02), and were less likely to experience aortic-related hemorrhage within 30 days postoperatively (3% aortic stump dehiscence vs. 11% anastomotic rupture, p=0.03). There were otherwise no significant differences in presentation, comorbidities, intra-operative or postoperative variables. Multivariable Cox regression showed the duration of antibiotic use (HR 0.92, 95% CI 0.86-0.98; p = 0.01) and rifampin use at time of discharge (HR 0.20, 0.05-0.86, p = 0.03) independently decreased mortality.CONCLUSIONS: These data suggest ISB does not offer a survival advantage compared to EAB and does not decrease the risk of postoperative aortic-related hemorrhage. Less than 50% of SAEF patients survive ten months after repair. Each week of antibiotic use decreases mortality by 8%. Further study with risk modeling are imperative for this population.

KW - Aorta

KW - Aortoenteric fistula

UR - http://www.scopus.com/inward/record.url?scp=85090120093&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2020.04.515

DO - 10.1016/j.jvs.2020.04.515

M3 - SCORING: Journal articles

C2 - 32445832

VL - 73

SP - 210-221.e1

JO - J VASC SURG

JF - J VASC SURG

SN - 0741-5214

IS - 1

ER -