Outcomes of Thoracic Endovascular Aortic Repair for Aortobronchial and Aortoesophageal Fistulas

Purpose: To identify in-hospital and follow-up outcomes of thoracic endovascular aortic repair (TEVAR) for aortobronchial fistula (ABF) and aortoesophageal fistula (AEF). Methods: The authors reviewed all published cases of ABF and AEF undergoing TEVAR indexed in the MEDLINE, Cochrane Library CENTRA...

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Veröffentlicht in:Journal of Endovascular Therapy 2009-08, Vol.16 (4), p.428-440
Hauptverfasser: Jonker, Frederik H.W., Schlösser, Felix J.V., Moll, Frans L., van Herwaarden, Joost A., Indes, Jeffrey E., Verhagen, Hence J.M., Muhs, Bart E.
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container_end_page 440
container_issue 4
container_start_page 428
container_title Journal of Endovascular Therapy
container_volume 16
creator Jonker, Frederik H.W.
Schlösser, Felix J.V.
Moll, Frans L.
van Herwaarden, Joost A.
Indes, Jeffrey E.
Verhagen, Hence J.M.
Muhs, Bart E.
description Purpose: To identify in-hospital and follow-up outcomes of thoracic endovascular aortic repair (TEVAR) for aortobronchial fistula (ABF) and aortoesophageal fistula (AEF). Methods: The authors reviewed all published cases of ABF and AEF undergoing TEVAR indexed in the MEDLINE, Cochrane Library CENTRAL, and EMBASE databases. After removal of duplicates, 850 articles were scrutinized for relevance and validity. Exclusion criteria included: (1) no clear description of the organs involved with the fistula, (2) no description of outcomes after TEVAR for ABF or AEF, or (3) no original data presented in the article. In this manner, 66 relevant articles were identified that included original data on 114 patients (76 men; mean age 63±1.5 years) with ABF (n=71) or AEF (n=43). Meta-analyses were performed to investigate outcomes of TEVAR for ABF and AEF. Results: Patients with AEF presented more frequently with hypovolemic shock (33% versus 13%, p=0.012) and systemic infection (36% versus 9%, p
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Methods: The authors reviewed all published cases of ABF and AEF undergoing TEVAR indexed in the MEDLINE, Cochrane Library CENTRAL, and EMBASE databases. After removal of duplicates, 850 articles were scrutinized for relevance and validity. Exclusion criteria included: (1) no clear description of the organs involved with the fistula, (2) no description of outcomes after TEVAR for ABF or AEF, or (3) no original data presented in the article. In this manner, 66 relevant articles were identified that included original data on 114 patients (76 men; mean age 63±1.5 years) with ABF (n=71) or AEF (n=43). Meta-analyses were performed to investigate outcomes of TEVAR for ABF and AEF. Results: Patients with AEF presented more frequently with hypovolemic shock (33% versus 13%, p=0.012) and systemic infection (36% versus 9%, p&lt;0.001) compared to patients with ABF. In-hospital mortality was 3% (n=2) after TEVAR for ABF and 19% (n=8) after TEVAR for AEF (p=0.004). Additional thoracic surgery in the first 30 days after TEVAR was performed in 3% (n=2) of ABF patients and in 37% (n=16) of AEF patients (p&lt;0.001); 12 AEF patients who had received esophageal surgery in the first month after TEVAR showed lower fistula-related mortality during 6 months of follow-up compared to patients who did not receive additional esophageal surgery (p=0.018). Conclusion: TEVAR is associated with superior outcomes in patients with ABF. Endovascular management of AEF is associated with poor results and should not be considered definitive treatment. TEVAR could serve as a bridge to surgery for emergency cases of AEF only, with definitive open surgical correction of the fistula undertaken as soon as possible.</description><identifier>ISSN: 1526-6028</identifier><identifier>EISSN: 1545-1550</identifier><identifier>DOI: 10.1583/09-2741R.1</identifier><identifier>PMID: 19702348</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Aged ; Antibiotics ; Aorta, Thoracic - diagnostic imaging ; Aorta, Thoracic - surgery ; Aortic Diseases - diagnosis ; Aortic Diseases - etiology ; Aortic Diseases - mortality ; Aortic Diseases - surgery ; Aortography - methods ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - mortality ; Bronchial Fistula - diagnosis ; Bronchial Fistula - etiology ; Bronchial Fistula - mortality ; Bronchial Fistula - surgery ; Bronchoscopy ; Data bases ; Digestive System Surgical Procedures ; Esophageal Fistula - diagnosis ; Esophageal Fistula - etiology ; Esophageal Fistula - mortality ; Esophageal Fistula - surgery ; Esophagus ; Evidence-Based Medicine ; Female ; Hospital Mortality ; Hospitalization ; Humans ; Intervention ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Mortality ; Patient care planning ; Patient Selection ; Patients ; Risk Assessment ; Sepsis ; Studies ; Thoracic surgery ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome ; Vascular Fistula - diagnosis ; Vascular Fistula - etiology ; Vascular Fistula - mortality ; Vascular Fistula - surgery</subject><ispartof>Journal of Endovascular Therapy, 2009-08, Vol.16 (4), p.428-440</ispartof><rights>2009 International Society of Endovascular Specialists</rights><rights>Copyright Allen Press Publishing Services Aug 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c410t-aff7471e107ac9d5fe40452bec39b5f2526fc246ab057a3b78ab7748f85484793</citedby><cites>FETCH-LOGICAL-c410t-aff7471e107ac9d5fe40452bec39b5f2526fc246ab057a3b78ab7748f85484793</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1583/09-2741R.1$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1583/09-2741R.1$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>313,314,780,784,792,21819,27922,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19702348$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jonker, Frederik H.W.</creatorcontrib><creatorcontrib>Schlösser, Felix J.V.</creatorcontrib><creatorcontrib>Moll, Frans L.</creatorcontrib><creatorcontrib>van Herwaarden, Joost A.</creatorcontrib><creatorcontrib>Indes, Jeffrey E.</creatorcontrib><creatorcontrib>Verhagen, Hence J.M.</creatorcontrib><creatorcontrib>Muhs, Bart E.</creatorcontrib><title>Outcomes of Thoracic Endovascular Aortic Repair for Aortobronchial and Aortoesophageal Fistulas</title><title>Journal of Endovascular Therapy</title><addtitle>J Endovasc Ther</addtitle><description>Purpose: To identify in-hospital and follow-up outcomes of thoracic endovascular aortic repair (TEVAR) for aortobronchial fistula (ABF) and aortoesophageal fistula (AEF). Methods: The authors reviewed all published cases of ABF and AEF undergoing TEVAR indexed in the MEDLINE, Cochrane Library CENTRAL, and EMBASE databases. After removal of duplicates, 850 articles were scrutinized for relevance and validity. Exclusion criteria included: (1) no clear description of the organs involved with the fistula, (2) no description of outcomes after TEVAR for ABF or AEF, or (3) no original data presented in the article. In this manner, 66 relevant articles were identified that included original data on 114 patients (76 men; mean age 63±1.5 years) with ABF (n=71) or AEF (n=43). Meta-analyses were performed to investigate outcomes of TEVAR for ABF and AEF. Results: Patients with AEF presented more frequently with hypovolemic shock (33% versus 13%, p=0.012) and systemic infection (36% versus 9%, p&lt;0.001) compared to patients with ABF. In-hospital mortality was 3% (n=2) after TEVAR for ABF and 19% (n=8) after TEVAR for AEF (p=0.004). Additional thoracic surgery in the first 30 days after TEVAR was performed in 3% (n=2) of ABF patients and in 37% (n=16) of AEF patients (p&lt;0.001); 12 AEF patients who had received esophageal surgery in the first month after TEVAR showed lower fistula-related mortality during 6 months of follow-up compared to patients who did not receive additional esophageal surgery (p=0.018). Conclusion: TEVAR is associated with superior outcomes in patients with ABF. Endovascular management of AEF is associated with poor results and should not be considered definitive treatment. TEVAR could serve as a bridge to surgery for emergency cases of AEF only, with definitive open surgical correction of the fistula undertaken as soon as possible.</description><subject>Aged</subject><subject>Antibiotics</subject><subject>Aorta, Thoracic - diagnostic imaging</subject><subject>Aorta, Thoracic - surgery</subject><subject>Aortic Diseases - diagnosis</subject><subject>Aortic Diseases - etiology</subject><subject>Aortic Diseases - mortality</subject><subject>Aortic Diseases - surgery</subject><subject>Aortography - methods</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - mortality</subject><subject>Bronchial Fistula - diagnosis</subject><subject>Bronchial Fistula - etiology</subject><subject>Bronchial Fistula - mortality</subject><subject>Bronchial Fistula - surgery</subject><subject>Bronchoscopy</subject><subject>Data bases</subject><subject>Digestive System Surgical Procedures</subject><subject>Esophageal Fistula - diagnosis</subject><subject>Esophageal Fistula - etiology</subject><subject>Esophageal Fistula - mortality</subject><subject>Esophageal Fistula - surgery</subject><subject>Esophagus</subject><subject>Evidence-Based Medicine</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Intervention</subject><subject>Kaplan-Meier Estimate</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Patient care planning</subject><subject>Patient Selection</subject><subject>Patients</subject><subject>Risk Assessment</subject><subject>Sepsis</subject><subject>Studies</subject><subject>Thoracic surgery</subject><subject>Time Factors</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><subject>Vascular Fistula - diagnosis</subject><subject>Vascular Fistula - etiology</subject><subject>Vascular Fistula - mortality</subject><subject>Vascular Fistula - surgery</subject><issn>1526-6028</issn><issn>1545-1550</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNptkNFKwzAUhoMobk5vfAApXigInTlp0rSXY2wqDAZjXoc0TVxH18ykFXx7MzsYiFcJP1_-nPMhdAt4DCxLnnEeE05hNYYzNARGWQyM4fPDnaRxikk2QFfebzEmQAAu0QByjklCsyESy65Vdqd9ZE203lgnVaWiWVPaL-lVV0sXTaxrQ7bSe1m5yNg-sYWzjdpUso5kU_aR9na_kR86ZPPKt-G1v0YXRtZe3xzPEXqfz9bT13ixfHmbThaxooDbWBrDKQcNmEuVl8xoiikjhVZJXjBDwiJGEZrKAjMuk4JnsuCcZiZjNKM8T0booe_dO_vZad-KXeWVrmvZaNt5kfI0rM-TAN7_Abe2c02YTQQ3AAnkB-iph5Sz3jttxN5VO-m-BWBxcC5wLn6dCwjw3bGxK3a6PKFHyQF47AEf3Jy--6fqB3lMh-U</recordid><startdate>200908</startdate><enddate>200908</enddate><creator>Jonker, Frederik H.W.</creator><creator>Schlösser, Felix J.V.</creator><creator>Moll, Frans L.</creator><creator>van Herwaarden, Joost A.</creator><creator>Indes, Jeffrey E.</creator><creator>Verhagen, Hence J.M.</creator><creator>Muhs, Bart E.</creator><general>SAGE Publications</general><general>Allen Press Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>200908</creationdate><title>Outcomes of Thoracic Endovascular Aortic Repair for Aortobronchial and Aortoesophageal Fistulas</title><author>Jonker, Frederik H.W. ; Schlösser, Felix J.V. ; Moll, Frans L. ; van Herwaarden, Joost A. ; Indes, Jeffrey E. ; Verhagen, Hence J.M. ; Muhs, Bart E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c410t-aff7471e107ac9d5fe40452bec39b5f2526fc246ab057a3b78ab7748f85484793</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Antibiotics</topic><topic>Aorta, Thoracic - diagnostic imaging</topic><topic>Aorta, Thoracic - surgery</topic><topic>Aortic Diseases - diagnosis</topic><topic>Aortic Diseases - etiology</topic><topic>Aortic Diseases - mortality</topic><topic>Aortic Diseases - surgery</topic><topic>Aortography - methods</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - mortality</topic><topic>Bronchial Fistula - diagnosis</topic><topic>Bronchial Fistula - etiology</topic><topic>Bronchial Fistula - mortality</topic><topic>Bronchial Fistula - surgery</topic><topic>Bronchoscopy</topic><topic>Data bases</topic><topic>Digestive System Surgical Procedures</topic><topic>Esophageal Fistula - diagnosis</topic><topic>Esophageal Fistula - etiology</topic><topic>Esophageal Fistula - mortality</topic><topic>Esophageal Fistula - surgery</topic><topic>Esophagus</topic><topic>Evidence-Based Medicine</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Intervention</topic><topic>Kaplan-Meier Estimate</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Patient care planning</topic><topic>Patient Selection</topic><topic>Patients</topic><topic>Risk Assessment</topic><topic>Sepsis</topic><topic>Studies</topic><topic>Thoracic surgery</topic><topic>Time Factors</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><topic>Vascular Fistula - diagnosis</topic><topic>Vascular Fistula - etiology</topic><topic>Vascular Fistula - mortality</topic><topic>Vascular Fistula - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jonker, Frederik H.W.</creatorcontrib><creatorcontrib>Schlösser, Felix J.V.</creatorcontrib><creatorcontrib>Moll, Frans L.</creatorcontrib><creatorcontrib>van Herwaarden, Joost A.</creatorcontrib><creatorcontrib>Indes, Jeffrey E.</creatorcontrib><creatorcontrib>Verhagen, Hence J.M.</creatorcontrib><creatorcontrib>Muhs, Bart E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing &amp; 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Methods: The authors reviewed all published cases of ABF and AEF undergoing TEVAR indexed in the MEDLINE, Cochrane Library CENTRAL, and EMBASE databases. After removal of duplicates, 850 articles were scrutinized for relevance and validity. Exclusion criteria included: (1) no clear description of the organs involved with the fistula, (2) no description of outcomes after TEVAR for ABF or AEF, or (3) no original data presented in the article. In this manner, 66 relevant articles were identified that included original data on 114 patients (76 men; mean age 63±1.5 years) with ABF (n=71) or AEF (n=43). Meta-analyses were performed to investigate outcomes of TEVAR for ABF and AEF. Results: Patients with AEF presented more frequently with hypovolemic shock (33% versus 13%, p=0.012) and systemic infection (36% versus 9%, p&lt;0.001) compared to patients with ABF. In-hospital mortality was 3% (n=2) after TEVAR for ABF and 19% (n=8) after TEVAR for AEF (p=0.004). Additional thoracic surgery in the first 30 days after TEVAR was performed in 3% (n=2) of ABF patients and in 37% (n=16) of AEF patients (p&lt;0.001); 12 AEF patients who had received esophageal surgery in the first month after TEVAR showed lower fistula-related mortality during 6 months of follow-up compared to patients who did not receive additional esophageal surgery (p=0.018). Conclusion: TEVAR is associated with superior outcomes in patients with ABF. Endovascular management of AEF is associated with poor results and should not be considered definitive treatment. TEVAR could serve as a bridge to surgery for emergency cases of AEF only, with definitive open surgical correction of the fistula undertaken as soon as possible.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>19702348</pmid><doi>10.1583/09-2741R.1</doi><tpages>13</tpages></addata></record>
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subjects Aged
Antibiotics
Aorta, Thoracic - diagnostic imaging
Aorta, Thoracic - surgery
Aortic Diseases - diagnosis
Aortic Diseases - etiology
Aortic Diseases - mortality
Aortic Diseases - surgery
Aortography - methods
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - mortality
Bronchial Fistula - diagnosis
Bronchial Fistula - etiology
Bronchial Fistula - mortality
Bronchial Fistula - surgery
Bronchoscopy
Data bases
Digestive System Surgical Procedures
Esophageal Fistula - diagnosis
Esophageal Fistula - etiology
Esophageal Fistula - mortality
Esophageal Fistula - surgery
Esophagus
Evidence-Based Medicine
Female
Hospital Mortality
Hospitalization
Humans
Intervention
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Mortality
Patient care planning
Patient Selection
Patients
Risk Assessment
Sepsis
Studies
Thoracic surgery
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Vascular Fistula - diagnosis
Vascular Fistula - etiology
Vascular Fistula - mortality
Vascular Fistula - surgery
title Outcomes of Thoracic Endovascular Aortic Repair for Aortobronchial and Aortoesophageal Fistulas
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