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      Is EVAR the treatment of choice for aortoenteric fistula?

      1 , ,   ,
      The Journal of cardiovascular surgery

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          Abstract

          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.

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          Author and article information

          Journal
          J Cardiovasc Surg (Torino)
          The Journal of cardiovascular surgery
          0021-9509
          0021-9509
          Jun 2010
          : 51
          : 3
          Affiliations
          [1 ] Department of Vascular Surgery Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
          Article
          R37106328
          20523281
          9dbd410f-7616-4937-94c9-3f34179be840
          History

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