O-009 - SECONDARY AORTO-ENTERIC FISTULAS IN AUSTRALASIA: A MULTI-CENTRE RETROSPECTIVE REVIEW

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Hanna J. (Department of Vascular Surgery, Waikato Hospital ~ Hamilton ~ New Zealand) , Narayanan A. (Department of Vascular Surgery, Wellington Hospital ~ Wellington ~ New Zealand) , Okamura-Kho A. (Department of Vascular Surgery, Auckland hospital ~ Auckland ~ New Zealand) , Tesar J. (Department of Vascular Surgery, Royal Brisbane and Women's Hospital ~ Brisbane ~ Australia) , Dean A. (Department of Vascular Surgery, Auckland hospital ~ Auckland ~ New Zealand) , Katib N. (Department of Vascular Surgery, Prince of Wales Hospital ~ Sydney ~ Australia) , Taumoepeau L. (Department of Vascular Surgery, Wellington Hospital ~ Wellington ~ New Zealand) , Khashram M. (Department of Vascular Surgery, Waikato Hospital ~ Hamilton ~ New Zealand)
Introduction:
Secondary aorto-enteric fistula (SAEF) is defined as an abnormal communication between the aorta and adjacent bowel resulting from reconstructive surgery of the aorta. SAEF represents a rare but life-threatening complication following abdominal aortic surgery, associated with high morbidity and mortality. Optimal immediate and long-term management strategies remain controversial, particularly with the emergence of endovascular repair as a potential option. The aim of this study was to report the treatment methods and outcomes of SAEF treatment across 4 tertiary centres in Australia and New Zealand.
Methods:
This was a retrospective observational cohort study design. Infected aortic grafts managed at 4 tertiary referral vascular centres in Australia and New Zealand were identified through the Australasian Vascular Audit Registry and local hospital databases between 2005 and 2020. Cases of SAEF or aorto-enteric erosion were included if they were diagnosed clinically at the time of laparotomy, endoscopy or radiologically by computerised tomography, and/or radionuclide scan. A review of electronic and paper patient records was performed. Case demographics and comorbidities, clinical presentation, microbiology results, operative details, microbiology results and outcomes were collected. The primary outcome was mortality at 30 days and 12 months. Kaplan-Meier and cox-regression analysis was used to analyse survival.
Results:
41 patients treated for SAEF identified, 86% were male with a mean age at presentation of 72. Twenty-two (54%) were treated with open repair, 12 (29%) with endovascular repair initially, and 7 (17%) non-operatively. The overall 30-day and 1-year mortality was 22% and 46%, respectively. On adjusted cox-regression analysis, there was no statistically significant difference in mortality in the endovascular repair group compared to the open repair group 0.973 (CI 95% 0.931-1.106).
Conclusion:
Our data presents the largest report of secondary AEF in Australasia with a reasonable sample size given the low incidence. Although short-term mortality has improved since earlier reports, secondary AEF remains a problematic entity with high morbidity and mortality. A multi-disciplinary group involving radiologist, microbiologists and infectious disease specialists, vascular surgeons and general surgeons are critical to managing this complex cohort of patients. With the growing improvement in endovascular therapy, we recommend a prospective registry in order to obtain further insight into these patients.