Aortic prosthetic graft infection accompanied with esophagomediastinal fistulas: A case report

Surgical treatment for secondary aortoesophageal fistula after prosthetic aortic replacement: A report of four cases

•

Secondary aortoesophageal fistula (AEF) after aortic prosthetic replacement is rare, so there have been few reports assembling multiple cases.

•

AEF is difficult to diagnose early if there is little experience, and hence is associated with high mortality and morbidity rates.

•

The strategy involving stepwise surgery in coordination with infection control and general health improvement was attempted in our facility.

•

From our observations, this approach appears to be a valid strategy for secondary AEF after aortic prosthetic replacement.

Introduction

With the increase of thoracic aortic aneurysm surgery and thoracic endovascular aortic repair, secondary aortoesophageal fistula (AEF) has been reported. However, the treatment strategy for AEF remains controversial.

Presentation of cases

Four patients who had undergone prosthetic aortic replacement for thoracic aortic aneurysm 4–36 months previously, were hospitalized with sepsis-like symptoms. They were diagnosed with aortic prosthetic graft infection after computed tomography revealed ectopic gas around the prosthesis. After that, esophagogastroduodenoscopy revealed an esophageal perforation, so we diagnosed AEF. They received medication and stepwise surgery; 1 patient was discharged, 2 remain hospitalized, and 1 died.

Discussion

Some reports have suggested that combined surgery provides better outcomes for AEF. Infection may be controlled by esophagectomy and antibiotic treatment, so prosthesis replacement is not always necessary. However, we should note that infection between a prosthetic graft and the native aorta brings a danger of pseudoaneurysm of the anastomosis.

Conclusion

Based on our experience we conclude that surgery performed stepwise along with infection control and general health improvement is a valid treatment strategy for secondary AEF after prosthetic aortic replacement.

Perigraft Abscess Subsequent to Aortoesophageal Fistula

A 79-year-old man with appetite loss and nausea for 1 month was admitted to our hospital. His thoracic aortic aneurysm had gradually increased in size due to perigraft endoleak after the previous aneurysm repair surgery. Although he showed no hematemesis, melena, or a fever, gastrointestinal endoscopy and contrast-enhanced computed tomography (CT) revealed an aortoesophageal fistula (AEF). He developed septic shock due to a perigraft abscess and eventually died, although aortic graft replacement and esophageal transection were performed. Clinical suspicion is the most important factor for obtaining an accurate diagnosis and improving the prognosis in cases of AEF.