PMID- 29207434 OWN - NLM STAT- MEDLINE DCOM- 20181009 LR - 20181009 IS - 1439-1902 (Electronic) IS - 0171-6425 (Linking) VI - 66 IP - 3 DP - 2018 Apr TI - Role of Endovascular Aortic Repair in the Treatment of Infected Aortic Aneurysms Complicated by Aortoenteric or Aortobronchial Fistulae. PG - 240-247 LID - 10.1055/s-0037-1608834 [doi] AB - BACKGROUND: The aim of this study was to compare outcomes and identify factors related to increased mortality of open surgical and endovascular aortic repair (EVAR) of primary mycotic aortic aneurysms complicated by aortoenteric fistula (AEF) or aortobronchial fistula (ABF). METHODS: Patients with primary mycotic aortic aneurysms complicated by an AEF or ABF treated by open surgery or endovascular repair between January 1993 and January 2014 were retrospectively reviewed. Outcomes were compared between the open surgery and endovascular groups, and a Cox's proportional hazard model was used to determine factors associated with mortality. RESULTS: A total of 29 patients included 14 received open surgery and 15 received endovascular repair. Positive initial bacterial blood culture results included Salmonella spp., oxacillin-resistant Staphylococcus aureus, and Klebsiella pneumoniae. Mortality within 1 month of surgery was higher in the open surgery than in the endovascular group (43 vs. 7%, respectively, p = 0.035). Shock, additional surgery to repair gastrointestinal (GI) or airway pathology, and aneurysm rupture were associated with a higher risk of death. Compared with patients without resection surgery, the adjusted hazard ratio of death within 4 years in patients with resection for GI/bronchial disease was 0.25. Survival within 6 months was better in the endovascular group (p = 0.016). CONCLUSION: The results of this study showed that EVAR/thoracic EVAR (TEVAR) is feasible for the management of infected aortic aneurysms complicated by an AEF or ABF, and results in good short-term outcomes. However, EVAR/TEVAR did not benefit long-term survival compared with open surgery. CI - Georg Thieme Verlag KG Stuttgart . New York. FAU - Kan, Chung-Dann AU - Kan CD AD - Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. FAU - Lee, Hsin-Ling AU - Lee HL AD - Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. FAU - Yang, Yu-Jen AU - Yang YJ AD - Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. AD - Department of Surgery, Kuo General Hospital, Tainan, Taiwan. LA - eng PT - Comparative Study PT - Journal Article DEP - 20171205 PL - Germany TA - Thorac Cardiovasc Surg JT - The Thoracic and cardiovascular surgeon JID - 7903387 SB - IM MH - Aged MH - Aneurysm, Infected/diagnostic imaging/microbiology/mortality/*surgery MH - Aortic Aneurysm/diagnostic imaging/microbiology/mortality/*surgery MH - *Blood Vessel Prosthesis Implantation/adverse effects/mortality MH - Bronchial Fistula/diagnostic imaging/microbiology/mortality/*surgery MH - *Endovascular Procedures/adverse effects/mortality MH - Feasibility Studies MH - Female MH - Humans MH - Intestinal Fistula/diagnostic imaging/microbiology/mortality/*surgery MH - Kaplan-Meier Estimate MH - Male MH - Middle Aged MH - Proportional Hazards Models MH - Retrospective Studies MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - Vascular Fistula/diagnostic imaging/microbiology/mortality/*surgery COIS- None. EDAT- 2017/12/06 06:00 MHDA- 2018/10/10 06:00 CRDT- 2017/12/06 06:00 PHST- 2017/12/06 06:00 [pubmed] PHST- 2018/10/10 06:00 [medline] PHST- 2017/12/06 06:00 [entrez] AID - 10.1055/s-0037-1608834 [doi] PST - ppublish SO - Thorac Cardiovasc Surg. 2018 Apr;66(3):240-247. doi: 10.1055/s-0037-1608834. Epub 2017 Dec 5.