Surgical treatment for secondary aortoesophageal fistula after prosthetic aortic replacement: A report of four cases.
Int J Surg Case Rep 2020;
75:37-41. [PMID:
32911186 PMCID:
PMC7486574 DOI:
10.1016/j.ijscr.2020.08.021]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/16/2020] [Accepted: 08/16/2020] [Indexed: 11/21/2022] Open
Abstract
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.
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