Document Detail


What to do when evidence is lacking--implications on treatment of aortic ulcers, pseudoaneurysms and aorto-enteric fistulae.
MedLine Citation:
PMID:  18575037     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Present knowledge on natural history and how to treat penetrating aortic ulcers or different forms of pseudoaneurysms with or without infection is limited as there are only case reports and small series of unusual aortic pathology and its treatment available. MATERIAL: From our centre we collected 65 patients treated with open (n = 15) or endovascular reconstruction (n= 50) during a 20-year period in the abdominal aorta. These patients are presented including a review of contemporary treatment. RESULTS: Endovascular reconstructions seem to reduce morbidity and mortality compared to otherwise extensive open surgery. Even for patients with infectious etiology (mycotic aneurysms, aorto-enteric fistula) endovascular treatment may be a first-hand option bridging to a more elective open repair. However, a large proportion of patients being unfit for further open surgery were solely treated endovascularly and had no major infectious complications in the follow-up. Registers of cases with unusual aortic pathology, not only of those treated but also of those managed conservatively, are needed to define who to treat and if endovascular or open repair should be recommended. CONCLUSION: Endovascular technique is a promising technique for treatment of aortic pseudoaneurysms of different etiologies. We firmly recommend, despite the lack of evidence, that the work up of patients with penetrating aortic ulcers, mycotic or other types of pseudoanerysms as well as aorto-enteric fistulae should enclose both endovascular and open (or combined) treatment modalities. However, our knowledge of the natural history is limited. Therefore, registers of cases with unusual aortic pathology, not only of those treated but also of those managed conservatively, are needed to define who to treat and if endovascular or open repair should be recommended.
Authors:
B Lindblad; J Holst; T Kölbel; K Ivancev;
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society     Volume:  97     ISSN:  1457-4969     ISO Abbreviation:  Scand J Surg     Publication Date:  2008  
Date Detail:
Created Date:  2008-06-25     Completed Date:  2008-10-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101144297     Medline TA:  Scand J Surg     Country:  Finland    
Other Details:
Languages:  eng     Pagination:  165-73     Citation Subset:  IM    
Affiliation:
Centre of Vascular Disease, Malmö University Hospital, Lund University, Malmö, Sweden. bengt.lindblad@med.lu.se
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aneurysm, False / surgery,  therapy*
Aortic Diseases / surgery,  therapy*
Female
Humans
Infection / therapy
Intestinal Fistula / surgery,  therapy*
Male
Middle Aged
Ulcer / surgery,  therapy*
Vascular Fistula / surgery,  therapy*

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