{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T17:40:22Z","timestamp":1789926022782,"version":"4.0.1"},"reference-count":14,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T00:00:00Z","timestamp":1659052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: To present our experience with various therapeutic approaches for the treatment of secondary aortoenteric fistulas following open and endovascular aortic aneurysm repair. Methods and Materials: A retrospective data analysis of patients treated for secondary aortoenteric fistulas in a single vascular institution between January 2005 and December 2018 was performed. Analyzed parameters included patients\u2019 demographics, clinical presentation, diagnostic work-up, perioperative data and repair durability during follow-up. Results: Twenty-three patients with aortoenteric fistulas were treated in the target period. The fistulous connection was located in 21 cases (91.3%) in the duodenum and in two cases (8.7%) in the small intestine. Average time between the initial procedure and detection of the aortoenteric fistula was 69.4 \u00b1 72.5 months. The most common presenting symptom was gastrointestinal bleeding (n = 12, 52.2%), followed by symptoms suggestive of chronic infection (n = 11, 47.8%). Open surgical repair was performed in 19 patients (bridging in 3 patients), and endovascular repair was carried out in two cases and one patient underwent a hybrid operation. One patient underwent abscess drainage due to significant comorbidities. Mean follow-up was 35.1 \u00b1 35.5 months. In-hospital mortality and overall mortality were 43.5% (10\/23) and 65.2% (15\/23), respectively. Patients presenting with bleeding had a significantly higher perioperative mortality rate in comparison to patients presenting with chronic infection (66.7% (8\/12) and 18.2% (2\/11), respectively, p = 0.019). Patients who underwent stent-graft implantation for control of acute life-threatening bleeding showed significantly better perioperative survival in comparison to patients that were acutely treated with an open procedure (66.6%, (4\/6) and 0% (0\/6), respectively, p = 0.014). Perioperative mortality was also higher for ASA IV patients (71.4%, 5\/7), when compared to ASA III Patients (31.2%, 5\/16), although this did not reach statistical significance (p = 0.074). Conclusion: Treatment of secondary aortoenteric fistulas is associated with a high perioperative mortality rate. Patients who survive the perioperative period following open surgical repair in the absence of hemorrhagic shock show acceptable midterm results during follow-up. Stent-graft implantation for bleeding control in patients presenting with life-threatening bleeding seems to be associated with lower perioperative mortality rates.<\/jats:p>","DOI":"10.3390\/jcm11154427","type":"journal-article","created":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T02:06:42Z","timestamp":1659319602000},"page":"4427","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Treatment of Secondary Aortoenteric Fistulas Following AORTIC Aneurysm Repair in a Tertiary Reference Center"],"prefix":"10.3390","volume":"11","author":[{"given":"Kyriakos","family":"Oikonomou","sequence":"first","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"},{"name":"Department of Vascular and Endovascular Surgery, Cardiovascular Surgery Clinic, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Pfister","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Kasprzak","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3276-9063","authenticated-orcid":false,"given":"Wilma","family":"Schierling","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Betz","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Sachsamanis","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,29]]},"reference":[{"key":"ref_1","unstructured":"Cooper, A. (1824). The Lectures of the Principles and Practice of Surgery with Additional Notes and Cases by Frederick Tyrrell, Thomas & George Underwood."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1016\/j.ejvs.2016.09.014","article-title":"Hellenic Co-operative Group on Aortic Surgery. Management of secondary aorto-enteric and other abdominal arterio-enteric fistulas: A review and pooled data analysis","volume":"52","author":"Kakkos","year":"2016","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/j.jvs.2008.08.068","article-title":"Outcome after endovascular stent graft repair of aortoenteric fistula: A systematic review","volume":"49","author":"Antoniou","year":"2009","journal-title":"J. Vasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1024\/0301-1526\/a000084","article-title":"Secondary aorto-enteric fistula\u2014Still a devastating complication of major vascular surgery","volume":"40","author":"Lukasiewicz","year":"2011","journal-title":"Vasa"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Luo, J., Tang, W., Wang, M., Xiao, Y., Tan, M., and Jiang, C. (2021). Case series of aortoenteric fistulas: A rare cause of gastrointestinal bleeding. BMC Gastroenterol., 21.","DOI":"10.1186\/s12876-021-01629-4"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/j.ejvs.2021.06.018","article-title":"Adjuncts to the Management of Graft Aorto-Enteric Erosion and Fistula with in situ Reconstruction","volume":"62","author":"Mauriac","year":"2021","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.ejvs.2019.10.016","article-title":"Editor\u2019s Choice\u2014European Society for Vacular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections","volume":"59","author":"Chakfe","year":"2020","journal-title":"Eur. J. Vasc. Enodvasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"160","DOI":"10.23736\/S0021-9509.22.12063-X","article-title":"Neoaortoiliac system in treating aortic graft infections: A single center long-term experience and review of the literature","volume":"63","author":"Castronovo","year":"2022","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"378.e1","DOI":"10.1016\/j.avsg.2022.01.009","article-title":"Endovascular Management of Bleeding Aortoenteric Fistula may be feasible as a Definitive Repair","volume":"83","author":"Singh","year":"2022","journal-title":"Ann. Vasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1089\/sur.2021.301","article-title":"In Situ Reconstruction with Autologous Veins for the Treatment of Infected Abdominal Endografts: Single Center Experience","volume":"23","author":"Mufty","year":"2022","journal-title":"Surg. Infect."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1016\/S1078-5884(03)00379-4","article-title":"Early and long-term results of conventional surgical treatment of secondary aorto-enteric fistula","volume":"26","author":"Dorigo","year":"2003","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/j.jvs.2021.08.094","article-title":"Fifteen-year, single-center experience with in situ reconstruction for infected native aortic aneurzsms","volume":"75","author":"Berard","year":"2022","journal-title":"J. Vasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/j.ejvs.2021.09.004","article-title":"Deep Femoral Vein Reconstruction for Abdominal Aortic Graft Infections is Associated with Low Aneurysm Related Mortality and a High Rate of Permanent Discontinuation of Antimicrobial Treatment","volume":"62","author":"Persson","year":"2021","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.ejvs.2008.09.023","article-title":"Secondary arterioenteric fistulation. A systematic literature analysis","volume":"37","author":"Bergqvist","year":"2009","journal-title":"Eur. J. Vasc. Endovasc. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/15\/4427\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:59:20Z","timestamp":1760140760000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/15\/4427"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,29]]},"references-count":14,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["jcm11154427"],"URL":"https:\/\/doi.org\/10.3390\/jcm11154427","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,29]]}}}