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ludc webb

Nuno Dias

Associate professor

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Is EVAR the treatment of choice for aortoenteric fistula?

Author

  • L Lonn
  • Nuno Dias
  • T Veith Schroeder
  • Tim Resch

Summary, in English

Aortoenteric fistula formation is a devastating condition regardless of whether it is primary or secondary (i.e. after previous aneurysm repair) in nature. Patients present with signs and symptoms of gastrointestinal bleeding with or without signs of systemic infection and are often in a very poor clinical condition. Conventional treatment consists of extensive open surgery (extra-anatomical bypass or aortic ligation), closure of fistula tract and complete removal of any prosthetic material. This treatment is associated with high morbidity and mortality and therefore more minimally invasive options with endovascular repair have been attempted. Endovascular repair is often successful in the short-term achieving favorable immediate outcome. In the presence of systemic infection, however, EVAR alone as an ultimate solution is often followed by repeat infection and bleeding. A staged combination of EVAR treatment for acute bleeding and aggressive infection treatment with systemic and local antibiotics, surgical abscess revision and fistula tract closure might be an option in fragile patients. For patients fit for open repair, EVAR can be used as a bridging procedure to definitive repair particularly in the setting of systemic infection.

Department/s

  • Vascular Diseases - Clinical Research

Publishing year

2010

Language

English

Pages

319-327

Publication/Series

Journal of Cardiovascular Surgery

Volume

51

Issue

3

Document type

Journal article

Publisher

Edizioni Minerva Medica

Topic

  • Cardiac and Cardiovascular Systems

Status

Published

Research group

  • Vascular Diseases - Clinical Research

ISBN/ISSN/Other

  • ISSN: 0021-9509