Results from the Multicenter Study on Aortoenteric Fistulization After Stent Grafting of the Abdominal Aorta (MAEFISTO)

Andrea Kahlberg, Enrico Rinaldi, Gabriele Piffaretti, F. Speziale, Santi Trimarchi, Stefano Bonardelli, Germano Melissano, Roberto Chiesa, Andrea Kahlberg, Enrico Rinaldi, L. Apruzzi, Y. Tshomba, Germano Melissano, Roberto Chiesa, G. Piffaretti, Patrizio Castelli, Laura Capoccia, P. Sirignano, Francesco Speziale, Sara SegretiSanti Trimarchi, Edoardo Cervi, Stefano Bonardelli, E. S. Costantini, Vittorio Baratta, Raffaello Bellosta, Antonio Sarcina

Research output: Contribution to journalArticle

Abstract

Objective This study investigated the frequency, clinical features, therapeutic options, and results of aortoenteric fistulas (AEFs) developing after endovascular abdominal aortic repair (EVAR). Methods Eight Italian centers with an EVAR program participated in this retrospective multicenter study and collected data on AEFs that developed after a previous EVAR. Results A total of 3932 patients underwent EVAR between 1997 and 2013 at the participating centers. During the same period, 32 patients presented with an AEF during EVAR follow-up, 21 with original EVAR performed for atherosclerotic aneurysmal disease (ATS group) and 11 with the original EVAR performed for a postsurgical pseudoaneurysm (PSA group). The incidence of AEF development after EVAR was 0.46% in the ATS group and 3.9% in the PSA group. Anastomotic PSA as the indication to EVAR (P <.0001) and urgent/emergency EVAR (P =.01) were significantly associated with AEF development. Median time between EVAR and the AEF diagnosis was 32 months (interquartile range, 11-75 months) for the ATS group and 14 months (interquartile range, 10.5-21.5 months) for the PSA group. Among five AEF patients treated conservatively, two (40%) died, at 7 and 15 months, and the remaining three were alive at a median follow-up of 12 months. The AEF was treated surgically in 27 patients, including aortic stent graft explantation in all cases, in situ aortic reconstruction in 14 (52%), and extra-anatomic bypass in 13 (48%). Perioperative mortality was 37% (10 of 27). No additional aortic-related death was recorded in operated-on patients at a median follow-up of 28 months. Conclusions Late AEFs rarely occur during EVAR follow-up, but the risk is significantly increased when EVAR is performed for PSA after previous aortic surgery and EVAR is performed as an emergency. Conservative and surgical treatment of post-EVAR AEF are both associated with high mortality. However, beyond the perioperative period, surgical correction of AEFs appears to be durable at midterm follow-up.

Original languageEnglish
Pages (from-to)313-320.e1
JournalJournal of Vascular Surgery
Volume64
Issue number2
DOIs
Publication statusPublished - Aug 1 2016

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Abdominal Aorta
Multicenter Studies
Fistula
Stents
Emergencies
Perioperative Period
Mortality
False Aneurysm
Retrospective Studies
Transplants

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Kahlberg, A., Rinaldi, E., Piffaretti, G., Speziale, F., Trimarchi, S., Bonardelli, S., ... Sarcina, A. (2016). Results from the Multicenter Study on Aortoenteric Fistulization After Stent Grafting of the Abdominal Aorta (MAEFISTO). Journal of Vascular Surgery, 64(2), 313-320.e1. https://doi.org/10.1016/j.jvs.2016.04.008

Results from the Multicenter Study on Aortoenteric Fistulization After Stent Grafting of the Abdominal Aorta (MAEFISTO). / Kahlberg, Andrea; Rinaldi, Enrico; Piffaretti, Gabriele; Speziale, F.; Trimarchi, Santi; Bonardelli, Stefano; Melissano, Germano; Chiesa, Roberto; Kahlberg, Andrea; Rinaldi, Enrico; Apruzzi, L.; Tshomba, Y.; Melissano, Germano; Chiesa, Roberto; Piffaretti, G.; Castelli, Patrizio; Capoccia, Laura; Sirignano, P.; Speziale, Francesco; Segreti, Sara; Trimarchi, Santi; Cervi, Edoardo; Bonardelli, Stefano; Costantini, E. S.; Baratta, Vittorio; Bellosta, Raffaello; Sarcina, Antonio.

In: Journal of Vascular Surgery, Vol. 64, No. 2, 01.08.2016, p. 313-320.e1.

Research output: Contribution to journalArticle

Kahlberg, A, Rinaldi, E, Piffaretti, G, Speziale, F, Trimarchi, S, Bonardelli, S, Melissano, G, Chiesa, R, Kahlberg, A, Rinaldi, E, Apruzzi, L, Tshomba, Y, Melissano, G, Chiesa, R, Piffaretti, G, Castelli, P, Capoccia, L, Sirignano, P, Speziale, F, Segreti, S, Trimarchi, S, Cervi, E, Bonardelli, S, Costantini, ES, Baratta, V, Bellosta, R & Sarcina, A 2016, 'Results from the Multicenter Study on Aortoenteric Fistulization After Stent Grafting of the Abdominal Aorta (MAEFISTO)', Journal of Vascular Surgery, vol. 64, no. 2, pp. 313-320.e1. https://doi.org/10.1016/j.jvs.2016.04.008
Kahlberg, Andrea ; Rinaldi, Enrico ; Piffaretti, Gabriele ; Speziale, F. ; Trimarchi, Santi ; Bonardelli, Stefano ; Melissano, Germano ; Chiesa, Roberto ; Kahlberg, Andrea ; Rinaldi, Enrico ; Apruzzi, L. ; Tshomba, Y. ; Melissano, Germano ; Chiesa, Roberto ; Piffaretti, G. ; Castelli, Patrizio ; Capoccia, Laura ; Sirignano, P. ; Speziale, Francesco ; Segreti, Sara ; Trimarchi, Santi ; Cervi, Edoardo ; Bonardelli, Stefano ; Costantini, E. S. ; Baratta, Vittorio ; Bellosta, Raffaello ; Sarcina, Antonio. / Results from the Multicenter Study on Aortoenteric Fistulization After Stent Grafting of the Abdominal Aorta (MAEFISTO). In: Journal of Vascular Surgery. 2016 ; Vol. 64, No. 2. pp. 313-320.e1.
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abstract = "Objective This study investigated the frequency, clinical features, therapeutic options, and results of aortoenteric fistulas (AEFs) developing after endovascular abdominal aortic repair (EVAR). Methods Eight Italian centers with an EVAR program participated in this retrospective multicenter study and collected data on AEFs that developed after a previous EVAR. Results A total of 3932 patients underwent EVAR between 1997 and 2013 at the participating centers. During the same period, 32 patients presented with an AEF during EVAR follow-up, 21 with original EVAR performed for atherosclerotic aneurysmal disease (ATS group) and 11 with the original EVAR performed for a postsurgical pseudoaneurysm (PSA group). The incidence of AEF development after EVAR was 0.46{\%} in the ATS group and 3.9{\%} in the PSA group. Anastomotic PSA as the indication to EVAR (P <.0001) and urgent/emergency EVAR (P =.01) were significantly associated with AEF development. Median time between EVAR and the AEF diagnosis was 32 months (interquartile range, 11-75 months) for the ATS group and 14 months (interquartile range, 10.5-21.5 months) for the PSA group. Among five AEF patients treated conservatively, two (40{\%}) died, at 7 and 15 months, and the remaining three were alive at a median follow-up of 12 months. The AEF was treated surgically in 27 patients, including aortic stent graft explantation in all cases, in situ aortic reconstruction in 14 (52{\%}), and extra-anatomic bypass in 13 (48{\%}). Perioperative mortality was 37{\%} (10 of 27). No additional aortic-related death was recorded in operated-on patients at a median follow-up of 28 months. Conclusions Late AEFs rarely occur during EVAR follow-up, but the risk is significantly increased when EVAR is performed for PSA after previous aortic surgery and EVAR is performed as an emergency. Conservative and surgical treatment of post-EVAR AEF are both associated with high mortality. However, beyond the perioperative period, surgical correction of AEFs appears to be durable at midterm follow-up.",
author = "Andrea Kahlberg and Enrico Rinaldi and Gabriele Piffaretti and F. Speziale and Santi Trimarchi and Stefano Bonardelli and Germano Melissano and Roberto Chiesa and Andrea Kahlberg and Enrico Rinaldi and L. Apruzzi and Y. Tshomba and Germano Melissano and Roberto Chiesa and G. Piffaretti and Patrizio Castelli and Laura Capoccia and P. Sirignano and Francesco Speziale and Sara Segreti and Santi Trimarchi and Edoardo Cervi and Stefano Bonardelli and Costantini, {E. S.} and Vittorio Baratta and Raffaello Bellosta and Antonio Sarcina",
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T1 - Results from the Multicenter Study on Aortoenteric Fistulization After Stent Grafting of the Abdominal Aorta (MAEFISTO)

AU - Kahlberg, Andrea

AU - Rinaldi, Enrico

AU - Piffaretti, Gabriele

AU - Speziale, F.

AU - Trimarchi, Santi

AU - Bonardelli, Stefano

AU - Melissano, Germano

AU - Chiesa, Roberto

AU - Kahlberg, Andrea

AU - Rinaldi, Enrico

AU - Apruzzi, L.

AU - Tshomba, Y.

AU - Melissano, Germano

AU - Chiesa, Roberto

AU - Piffaretti, G.

AU - Castelli, Patrizio

AU - Capoccia, Laura

AU - Sirignano, P.

AU - Speziale, Francesco

AU - Segreti, Sara

AU - Trimarchi, Santi

AU - Cervi, Edoardo

AU - Bonardelli, Stefano

AU - Costantini, E. S.

AU - Baratta, Vittorio

AU - Bellosta, Raffaello

AU - Sarcina, Antonio

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Objective This study investigated the frequency, clinical features, therapeutic options, and results of aortoenteric fistulas (AEFs) developing after endovascular abdominal aortic repair (EVAR). Methods Eight Italian centers with an EVAR program participated in this retrospective multicenter study and collected data on AEFs that developed after a previous EVAR. Results A total of 3932 patients underwent EVAR between 1997 and 2013 at the participating centers. During the same period, 32 patients presented with an AEF during EVAR follow-up, 21 with original EVAR performed for atherosclerotic aneurysmal disease (ATS group) and 11 with the original EVAR performed for a postsurgical pseudoaneurysm (PSA group). The incidence of AEF development after EVAR was 0.46% in the ATS group and 3.9% in the PSA group. Anastomotic PSA as the indication to EVAR (P <.0001) and urgent/emergency EVAR (P =.01) were significantly associated with AEF development. Median time between EVAR and the AEF diagnosis was 32 months (interquartile range, 11-75 months) for the ATS group and 14 months (interquartile range, 10.5-21.5 months) for the PSA group. Among five AEF patients treated conservatively, two (40%) died, at 7 and 15 months, and the remaining three were alive at a median follow-up of 12 months. The AEF was treated surgically in 27 patients, including aortic stent graft explantation in all cases, in situ aortic reconstruction in 14 (52%), and extra-anatomic bypass in 13 (48%). Perioperative mortality was 37% (10 of 27). No additional aortic-related death was recorded in operated-on patients at a median follow-up of 28 months. Conclusions Late AEFs rarely occur during EVAR follow-up, but the risk is significantly increased when EVAR is performed for PSA after previous aortic surgery and EVAR is performed as an emergency. Conservative and surgical treatment of post-EVAR AEF are both associated with high mortality. However, beyond the perioperative period, surgical correction of AEFs appears to be durable at midterm follow-up.

AB - Objective This study investigated the frequency, clinical features, therapeutic options, and results of aortoenteric fistulas (AEFs) developing after endovascular abdominal aortic repair (EVAR). Methods Eight Italian centers with an EVAR program participated in this retrospective multicenter study and collected data on AEFs that developed after a previous EVAR. Results A total of 3932 patients underwent EVAR between 1997 and 2013 at the participating centers. During the same period, 32 patients presented with an AEF during EVAR follow-up, 21 with original EVAR performed for atherosclerotic aneurysmal disease (ATS group) and 11 with the original EVAR performed for a postsurgical pseudoaneurysm (PSA group). The incidence of AEF development after EVAR was 0.46% in the ATS group and 3.9% in the PSA group. Anastomotic PSA as the indication to EVAR (P <.0001) and urgent/emergency EVAR (P =.01) were significantly associated with AEF development. Median time between EVAR and the AEF diagnosis was 32 months (interquartile range, 11-75 months) for the ATS group and 14 months (interquartile range, 10.5-21.5 months) for the PSA group. Among five AEF patients treated conservatively, two (40%) died, at 7 and 15 months, and the remaining three were alive at a median follow-up of 12 months. The AEF was treated surgically in 27 patients, including aortic stent graft explantation in all cases, in situ aortic reconstruction in 14 (52%), and extra-anatomic bypass in 13 (48%). Perioperative mortality was 37% (10 of 27). No additional aortic-related death was recorded in operated-on patients at a median follow-up of 28 months. Conclusions Late AEFs rarely occur during EVAR follow-up, but the risk is significantly increased when EVAR is performed for PSA after previous aortic surgery and EVAR is performed as an emergency. Conservative and surgical treatment of post-EVAR AEF are both associated with high mortality. However, beyond the perioperative period, surgical correction of AEFs appears to be durable at midterm follow-up.

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