Universität zu Köln

Czerny, Martin ORCID: 0000-0003-4766-9775, Eggebrecht, Holger, Sodeck, Gottfried, Weigang, Ernst, Livi, Ugolino, Verzini, Fabio, Schmidli, Juerg, Chiesa, Roberto, Melissano, Germano ORCID: 0000-0002-4168-1792, Kahlberg, Andrea, Amabile, Philippe, Harringer, Wolfgang, Horacek, Michael, Erbel, Raimund, Park, Kay-Hyun ORCID: 0000-0002-1111-9627, Beyersdorf, Friedhelm ORCID: 0000-0003-2975-2751, Rylski, Bartosz, Blanke, Philipp, Canaud, Ludovic, Khoynezhad, Ali, Lonn, Lars, Rousseau, Herve, Trimarchi, Santi ORCID: 0000-0001-5996-3264, Brunkwall, Jan, Gawenda, Michael, Dong, Zhihui, Fu, Weiguo, Schuster, Ingrid and Grimm, Michael (2014). New insights regarding the incidence, presentation and treatment options of aorto-oesophageal fistulation after thoracic endovascular aortic repair: the European Registry of Endovascular Aortic Repair Complications. Eur. J. Cardio-Thorac. Surg., 45 (3). S. 452 - 458. CARY: OXFORD UNIV PRESS INC. ISSN 1873-734X

Full text not available from this repository.

Abstract

OBJECTIVES: To review the incidence, clinical presentation, definite management and 1-year outcome in patients with aorto-oesophageal fistulation (AOF) following thoracic endovascular aortic repair (TEVAR). METHODS: International multicentre registry (European Registry of Endovascular Aortic Repair Complications) between 2001 and 2011 with a total caseload of 2387 TEVAR procedures (17 centres). RESULTS: Thirty-six patients with a median age of 69 years (IQR 56-75), 25% females and 9 patients (19%) following previous aortic surgery were identified. The incidence of AOF in the entire cohort after TEVAR in the study period was 1.5%. The primary underlying aortic pathology for TEVAR was atherosclerotic aneurysm formation in 53% of patients and the median time to development of AOF was 90 days (IQR 30-150). Leading clinical symptoms were fever of unknown origin in 29 (81%), haematemesis in 19 (53%) and shock in 8 (22%) patients. Diagnosis could be confirmed via computed tomography in 92% of the cases with the leading sign of a new mediastinal mass in 28 (78%) patients. A conservative approach resulted in a 100% 1-year mortality, and 1-year survival for an oesophageal stenting-only approach was 17%. Survival after isolated oesophagectomy was 43%. The highest 1-year survival rate (46%) could be achieved via an aggressive treatment including radical oesophagectomy and aortic replacement [ relative risk increase 1.73 95% confidence interval (CI) 1.03-2.92]. The survival advantage of this aggressive treatment modality could be confirmed in bootstrap analysis (95% CI 1.11-3.33). CONCLUSIONS: The development of AOF is a rare but lethal complication after TEVAR, being associated with the need for emergency TEVAR as well as mediastinal haematoma formation. The only durable and successful approach to cure the disease is radical oesophagectomy and extensive aortic reconstruction. These findings may serve as a decision-making tool for physicians treating these complex patients.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Czerny, Martin UNSPECIFIED orcid.org/0000-0003-4766-9775 UNSPECIFIED Eggebrecht, Holger UNSPECIFIED UNSPECIFIED UNSPECIFIED Sodeck, Gottfried UNSPECIFIED UNSPECIFIED UNSPECIFIED Weigang, Ernst UNSPECIFIED UNSPECIFIED UNSPECIFIED Livi, Ugolino UNSPECIFIED UNSPECIFIED UNSPECIFIED Verzini, Fabio UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidli, Juerg UNSPECIFIED UNSPECIFIED UNSPECIFIED Chiesa, Roberto UNSPECIFIED UNSPECIFIED UNSPECIFIED Melissano, Germano UNSPECIFIED orcid.org/0000-0002-4168-1792 UNSPECIFIED Kahlberg, Andrea UNSPECIFIED UNSPECIFIED UNSPECIFIED Amabile, Philippe UNSPECIFIED UNSPECIFIED UNSPECIFIED Harringer, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Horacek, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Erbel, Raimund UNSPECIFIED UNSPECIFIED UNSPECIFIED Park, Kay-Hyun UNSPECIFIED orcid.org/0000-0002-1111-9627 UNSPECIFIED Beyersdorf, Friedhelm UNSPECIFIED orcid.org/0000-0003-2975-2751 UNSPECIFIED Rylski, Bartosz UNSPECIFIED UNSPECIFIED UNSPECIFIED Blanke, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Canaud, Ludovic UNSPECIFIED UNSPECIFIED UNSPECIFIED Khoynezhad, Ali UNSPECIFIED UNSPECIFIED UNSPECIFIED Lonn, Lars UNSPECIFIED UNSPECIFIED UNSPECIFIED Rousseau, Herve UNSPECIFIED UNSPECIFIED UNSPECIFIED Trimarchi, Santi UNSPECIFIED orcid.org/0000-0001-5996-3264 UNSPECIFIED Brunkwall, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Gawenda, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Dong, Zhihui UNSPECIFIED UNSPECIFIED UNSPECIFIED Fu, Weiguo UNSPECIFIED UNSPECIFIED UNSPECIFIED Schuster, Ingrid UNSPECIFIED UNSPECIFIED UNSPECIFIED Grimm, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-445255
DOI:	10.1093/ejcts/ezt393
Journal or Publication Title:	Eur. J. Cardio-Thorac. Surg.
Volume:	45
Number:	3
Page Range:	S. 452 - 458
Date:	2014
Publisher:	OXFORD UNIV PRESS INC
Place of Publication:	CARY
ISSN:	1873-734X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language STENT-GRAFT PLACEMENT; SUCCESSFUL SURGICAL-TREATMENT; AORTOBRONCHIAL FISTULAS; TEVAR; INTERVENTIONS; DISSECTION; MECHANISMS; SURGERY Multiple languages Cardiac & Cardiovascular Systems; Respiratory System; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/44525