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Schoel LJ, Lagisetty K. Aorto-esophageal Fistula Management. Thorac Surg Clin 2024; 34:385-394. [PMID: 39332863 DOI: 10.1016/j.thorsurg.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2024]
Abstract
Aorto-esophageal fistula is a rare but life-threatening source of massive upper gastrointestinal bleeding. Prompt diagnosis and intervention are key for patient survival. Treatments consist of aortic resection, thoracic endovascular aortic repair, esophagectomy with diversion, and primary esophageal repair. The appropriate treatment is dependent on patient hemodynamics and fitness and familiarity with operative approaches by the treating team.
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Affiliation(s)
- Leah J Schoel
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
| | - Kiran Lagisetty
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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2
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Jin S, Wei G, Qu X, Li W. Surgical treatment of graft infection combined with aortoesophageal fistula after TEVAR: a retrospective single-center, single-arm study. J Cardiothorac Surg 2024; 19:535. [PMID: 39300469 DOI: 10.1186/s13019-024-03109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 09/15/2024] [Indexed: 09/22/2024] Open
Abstract
OBJECTIVE Aortoesophageal fistula (AEF) secondary to thoracic aortic endovascular repair (TEVAR) is rare and fatal. The author reports the treatment methods and outcomes of 10 patients with a TEVAR graft infection and an aortoesophageal fistula. METHOD A retrospective analysis was conducted on the clinical data of 10 patients who developed a secondary AEF and a graft infection after TEVAR from March 2018 to March 2024. RESULT The perioperative mortality rate was 70%. Two patients had TEVAR only and all died of bleeding and infection. Eight patients underwent open surgery, five died within 30 days, four of them died due to massive bleeding, the one patient died of a serious infection after surgery. Three patients recovered well and were discharged. One patient died of severe pneumonia 3 months after discharge, and two patients survived for 6 years and 3 months, respectively. CONCLUSION Extra-anatomical bypass reconstruction is feasible for treating graft infection combined with aortoesophageal fistula after TEVAR but related to bad outcomes in most of the patients. It is reserved for highly select patients and is performed at centers with experience with this procedure.
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Affiliation(s)
- Shanshan Jin
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Gonghe Wei
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Xiangrui Qu
- Capital Medical University, Beijing, 100069, China
| | - Wenrui Li
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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3
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Ikuno T, Sakakibara Y, Seki Y, Nishimura K. Two-Step Operation for Aortoesophageal Fistula After Thoracic Endovascular Repair. Cureus 2024; 16:e67169. [PMID: 39295722 PMCID: PMC11408958 DOI: 10.7759/cureus.67169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2024] [Indexed: 09/21/2024] Open
Abstract
Aortoesophageal fistula (AEF) caused after thoracic endovascular aortic repair (TEVAR) is rare but a serious complication. We report a successful staged operation for AEF after TEVAR. A 70-year-old male underwent TEVAR for a ruptured aneurysm of the descending aorta and subsequently developed AEF three months later. First, the patient underwent the resection of the esophagus, which was the focus of the infection under the right thoracoscopic approach. Second, descending aorta replacement was performed using a left thoracotomy approach. The patient has been well for about two years since the second operation without recurring graft infection. Staged operation with a different approach to the infection zone is a useful method for AEF.
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Affiliation(s)
- Takeshi Ikuno
- Department of Cardiac Surgery, Kyoto Medical Hospital, Kyoto, JPN
| | - Yutaka Sakakibara
- Department of Cardiovascular Surgery, Takamatsu Red Cross Hospital, Takamatsu, JPN
| | - Yusuke Seki
- Department of Cardiovascular Surgery, Takamatsu Red Cross Hospital, Takamatsu, JPN
| | - Kazunobu Nishimura
- Department of Cardiovascular Surgery, Takamatsu Red Cross Hospital, Takamatsu, JPN
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4
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Joseph KR, Singh J, Chin R, Lee A, Oborska Y, Mayorchak Y. A novel approach to surviving an acute aorto-oesophageal fistula: A case report. Int J Surg Case Rep 2024; 121:110035. [PMID: 39013248 PMCID: PMC11304060 DOI: 10.1016/j.ijscr.2024.110035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Acute aorto-oesophageal fistula poses a significant mortality risk, requiring immediate and decisive medical intervention. This report highlights the critical need for innovation in emergency surgical responses. CASE PRESENTATION A 57-year-old male, with a history of aortic repair, presented with chronic anaemia and dysphagia. He suffered a cardiac arrest from massive hematemesis during surgery for an infected thoracic hematoma. Lacking a Stengsten-Blackmore tube, a 26Fr Foley catheter was used to control the bleeding. This measure stabilized the patient enough for a definitive endovascular repair with aortic stents, which successfully managed the bleeding. CLINICAL DISCUSSION The treatment objectives for this condition include initial control of oesophageal bleeding, followed by endovascular management to further control the bleeding, subsequently releasing the oesophageal control, and ultimately preventing infection through the administration of intravenous antibiotics. CONCLUSION This case illustrates the importance of adaptability and the use of unconventional methods in emergency situations, demonstrating that innovative solutions can be lifesaving in critical surgical emergencies.
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Uemura H, Matsue H, Suehiro Y, Nakagawa T, Satoh A, Teshima Y, Bungo M, Satoh H. Surgical repair of an aortoesophageal fistula after salvage thoracic endovascular aortic repair: a case report. J Med Case Rep 2024; 18:285. [PMID: 38902817 PMCID: PMC11191166 DOI: 10.1186/s13256-024-04605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND An aortoesophageal fistula can prove to be fatal. Salvage thoracic endovascular aortic repair as a bridging therapy and radical surgery with thoracotomy should be considered while treating aortoesophageal fistula without spontaneous closure. Moreover, it is essential to select a technique that reduces the risk of reinfection. Here we report a rare case of a ruptured thoracic aortic aneurysm related to esophageal perforation by a fish bone that led to massive hematemesis and shock, and the surgical treatment of an aortoesophageal fistula that developed after salvage thoracic endovascular aortic repair. CASE PRESENTATION A 70-year-old Japanese female patient was admitted with hematemesis, thoracic pain, and shock related to esophageal perforation of a ruptured descending aortic aneurysm caused by fish bone aspiration and esophageal perforation 1 month previously. An emergency thoracic endovascular aortic repair was performed. Postoperatively, an aortoesophageal fistula that remained open and a food intake-related increase in the inflammatory response was noted. Radical blood-vessel prosthesis implantation and fistula closure were performed. The patient's postoperative course was favorable and the patient was discharged 22 days after the blood vessel prosthesis implantation. CONCLUSION Such a case of rupture of a descending aortic aneurysm related to perforation by a fish bone and an aortoesophageal fistula is considerably rare. Thus, we report the therapeutic strategy of this particular case and review the relevant literature.
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Affiliation(s)
- Hisashi Uemura
- Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho 2-1, Takarazuka, Hyogo, Japan
| | - Hajime Matsue
- Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho 2-1, Takarazuka, Hyogo, Japan
| | - Yasuo Suehiro
- Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho 2-1, Takarazuka, Hyogo, Japan
| | - Takaya Nakagawa
- Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho 2-1, Takarazuka, Hyogo, Japan
| | - Ayaka Satoh
- Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho 2-1, Takarazuka, Hyogo, Japan
| | - Yoshio Teshima
- Department of Cardiovascular Surgery, Hyogo Medical University, Hyogo, Japan
| | - Masashi Bungo
- Department of Cardiovascular Surgery, Hyogo Medical University, Hyogo, Japan
| | - Hisashi Satoh
- Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho 2-1, Takarazuka, Hyogo, Japan.
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6
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Mills A, Tanaka A, Dawson A, Hetz R, Smith H, Lopez M, Safi H, Estrera A. Management of aortoesophageal fistula primarily using esophageal preservation. JTCVS OPEN 2024; 19:31-38. [PMID: 39015446 PMCID: PMC11247201 DOI: 10.1016/j.xjon.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 07/18/2024]
Abstract
Objective Aortoesophageal fistula is a rare, life-threatening condition. There is no consensus regarding the surgical management of the esophagus in this condition. Methods We retrospectively evaluated 13 patients diagnosed with aortoesophageal fistulas at a single institution from 2003 to 2021. Descriptive statistics were used to analyze patient characteristics, operative characteristics, and patient outcomes. Kaplan-Meier survival analysis was performed. Results Patients' mean age was 63.5 years, and 6 (46.2%) were female. The most common presenting symptoms were hemoptysis/hematemesis (69.2%), chest/back pain (46.2%), and fever (38.5%). Twelve patients (92.3%) had a history of aortic procedures. The median time between the index operation and repair of the secondary aortoesophageal fistula in the 12 patients was 5 months. The index operation was a thoracic endovascular aortic repair in 10 of 12 patients (83.3%). Eleven patients (84.6%) underwent primary esophageal repair with flap coverage (omentum or muscle). One of these patients needed an esophagectomy within 1 year. The primary surgical management of the aorta was graft excision and replacement, aside from 1 patient who underwent primary repair. The 30-day survival was 69.2%, and 1-year and 5-year survivals were 31.7%. There were no recurrent infections at the esophageal fistula site. Conclusions Aortoesophageal fistula remains a rare condition, but its case numbers have increased with thoracic endovascular aortic repair. It continues to be a difficult condition to manage and has a high fatality rate. Esophageal-preserving surgery may be a safe and less-invasive option for patients with a small defect.
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Affiliation(s)
- Alexander Mills
- Department of General Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Akiko Tanaka
- Department of Cardiovascular and Thoracic Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Ashley Dawson
- Department of General Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Robert Hetz
- Department of Cardiovascular and Thoracic Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Holly Smith
- Department of Cardiovascular and Thoracic Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Michael Lopez
- Department of Cardiovascular and Thoracic Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Hazim Safi
- Department of Cardiovascular and Thoracic Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Anthony Estrera
- Department of Cardiovascular and Thoracic Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
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7
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Yamanaka K, Hasegawa S, Kawabata R, Shiraki H, Chomei S, Inoue T, Tsujimoto T, Miyahara S, Takahashi H, Okada K. Anterolateral thoracotomy with partial sternotomy: a feasible approach for treating the complex pathology of the aortic arch. Eur J Cardiothorac Surg 2024; 65:ezae138. [PMID: 38597899 DOI: 10.1093/ejcts/ezae138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/20/2024] [Accepted: 04/06/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES Our goal was to review our surgical experiences in patients with complex pathologies of the aortic arch who have undergone anterolateral thoracotomy with a partial sternotomy (ALPS). METHODS From October 2019 to November 2023, a total of 23 patients underwent one-stage repairs of complex pathologies of the aortic arch through the ALPS approach. The mean age was 61.9 ± 16.7 years old. The aortic pathologies were as follows: aorta-related infection in 11 (aorto-oesophageal fistula: 4, graft infection: 6, native aortic infection: 1); aortic dissection in 9 including shaggy aorta in 2, non-dissecting aneurysm in 1, and coarctation of the aorta (CoA) in 2. RESULTS Eighteen patients underwent aortic replacement from either the sinotubular junction or the ascending aorta to the descending aorta; 1 patient underwent it from the aortic root to the descending aorta (redo Bentall procedure and extensive aortic arch replacement); 3 patients underwent it from the aortic arch between the left carotid artery and left subclavian artery to the descending aorta; and 1 patient underwent a descending aortic replacement. Ten patients underwent omentopexy, latissimus dorsi muscle flap installation or both procedures. The hospital mortality rate was 13.0% (3/23). The overall survival and freedom from aortic events were 73.3%±10.2% and 74.1%±10.2%, respectively, at the 3-year follow-up. There was an absence of aorta-related deaths, and no recurrent infections were identified. CONCLUSIONS The short-term outcomes using the ALPS approach for the treatment of complex pathologies of the aortic arch were acceptable. Further studies will be required to determine the long-term results.
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Affiliation(s)
- Katsuhiro Yamanaka
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Shota Hasegawa
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Ryo Kawabata
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Hironaga Shiraki
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Shunya Chomei
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Taishi Inoue
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Takanori Tsujimoto
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Shunsuke Miyahara
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Hiroaki Takahashi
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Kenji Okada
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
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Saisho K, Mori N, Nakagawa M, Nakamura E, Tanaka Y, Kaku H, Tanaka Y, Isobe T, Otsuka H, Sudo T, Sakai H, Ishibashi N, Hisaka T, Tayama E, Fujita F. Aortoesophageal fistula due to esophageal cancer: a case report of successful management. Surg Case Rep 2024; 10:88. [PMID: 38630370 PMCID: PMC11024079 DOI: 10.1186/s40792-024-01893-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare but potentially life-threatening condition. The best treatment for the AEF due to esophageal carcinoma is still unresolved. Here, we report a rare case of AEF caused by esophageal cancer, that was successfully treated with emergency thoracic endovascular aortic repair (TEVAR), followed by esophagectomy and gastric tube reconstruction. CASE PRESENTATION A 64-year-old man presented with loss of consciousness and hypotension during chemoradiotherapy for advanced esophageal cancer. Enhanced computed tomography showed extravasation from the descending aorta into the esophagus at the tumor site. We performed emergency TEVAR for the AEF, which stabilized the hemodynamics. We then performed thoracoscopic subtotal esophagectomy on day 4 after TEVAR to prevent graft infection, followed by gastric tube reconstruction on day 30 after TEVAR. At 9 months after the onset of AEF, the patient continues to receive outpatient chemotherapy and leads a normal daily life. CONCLUSION TEVAR is a useful hemostatic procedure for AEF. If the patient is in good condition and can continue treatment for esophageal cancer, esophagectomy and reconstruction after TEVAR should be performed to prevent graft infection and maintain quality of life.
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Affiliation(s)
- Kohei Saisho
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Naoki Mori
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Masashi Nakagawa
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Eiji Nakamura
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yu Tanaka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hideaki Kaku
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yuya Tanaka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Taro Isobe
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hiroyuki Otsuka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tomoya Sudo
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hisamune Sakai
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Nobuya Ishibashi
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Toru Hisaka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Fumihiko Fujita
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
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Sakai M, Sohda M, Uchida S, Yamaguchi A, Watanabe T, Saito H, Nakazawa N, Kuriyama K, Sano A, Ogawa H, Yokobori T, Nagai K, Shirabe K, Saeki H. Efficacy of thoracic endovascular aortic repair for aorto-esophageal fistula due to esophageal cancer: a systematic review and meta-analysis. Esophagus 2024; 21:95-101. [PMID: 38302854 DOI: 10.1007/s10388-024-01042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/31/2023] [Indexed: 02/03/2024]
Abstract
Aorto-esophageal fistula (AEF) due to esophageal cancer (EC) is a life-threatening condition characterized by sudden hemorrhage, which often causes sudden death. To evaluate the efficacy and safety of thoracic endovascular aortic repair (TEVAR) for AEF due to EC, we performed a systematic review and meta-analysis. We searched the MEDLINE (PubMed) databases, the Cochrane Library databases, Ichushi-Web (the databases of the Japan Medical Abstract Society), and CiNii (Academic information search service of the National Institute of Information from Japan) from January 2000 to November 2023 for articles about TEVAR for an emergent aortic hemorrhage (salvage TEVAR [S-TEVAR]), and the prophylactic procedure (P-TEVAR). Six studies (140 cases) were eligible for meta-analysis. The 90-day mortality of S-TEVAR and P-TEVAR was 40% (95% CI 23-60, I2 = 36%) and 8% (95% CI 3-17, I2 = 0%), respectively. Post-S-TEVAR hemorrhagic and infectious complications were 17% (95% CI 3-57, I2 = 71%) and 20% (95% CI 5-57, I2 = 66%), respectively. Post-P-TEVAR hemorrhagic and infectious complications were 2% (95% CI 0-10, I2 = 0%) and 3% (95% CI 1-12, I2 = 0%), respectively. TEVAR for AEF due to EC may be a useful therapeutic option to manage or prevent hemorrhagic oncological emergencies.
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Affiliation(s)
- Makoto Sakai
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Makoto Sohda
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Shintaro Uchida
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Arisa Yamaguchi
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takayoshi Watanabe
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hideyuki Saito
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Nobuhiro Nakazawa
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kengo Kuriyama
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Akihiko Sano
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroomi Ogawa
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | | | - Kazue Nagai
- Gunma University Center for Food Science and Wellness, Maebashi, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hiroshi Saeki
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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10
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Yasumoto Y, Nakamura Y, Kobayashi R, Ogata K, Tsuruta R. Left anterior intrathoracic reconstruction of the esophagus with omental flap for infective proximal aortic repair. JTCVS Tech 2023; 21:224-226. [PMID: 37854819 PMCID: PMC10580093 DOI: 10.1016/j.xjtc.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Yuto Yasumoto
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Chiba, Japan
| | - Yoshitsugu Nakamura
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Chiba, Japan
| | | | - Kenji Ogata
- Department of Surgery, Chiba-Nishi General Hospital, Chiba, Japan
| | - Ryo Tsuruta
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, Chiba, Japan
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11
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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12
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Pranavan S, Mayorathan U, Munasinghe BM. A fatal aorto-oesophageal fistula due to a mutton bone: A case report. Int J Surg Case Rep 2023; 108:108478. [PMID: 37421771 PMCID: PMC10382798 DOI: 10.1016/j.ijscr.2023.108478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/10/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE OF THE CASE Aorto-oesophageal fistula (AEF) following foreign body ingestion is rare and conservative management is always fatal. The delayed presentation further confounds poor outcomes. PRESENTATION OF CASE A 46-year-old South-Asian woman presented with pain and difficulty in swallowing following ingestion of a mutton-containing meal. The patient refused urgent upper GI endoscopy and was initially managed conservatively on the basis of the resolution of symptoms and hemodynamic stability and was discharged home. On review a week later, the patient did not consent to a UGIE. She presented the next day with a severe upper GI bleed. Due to profuse haemorrhage, a bleeding point could not be identified, and she suffered a cardiac arrest. Attempts at resuscitation were unsuccessful. The autopsy revealed an AEF caused by a sharp mutton bone lodged in the lower oesophagus. CLINICAL DISCUSSION High-risk food bolus impactions such as the ones caused by sharp objects need urgent endoscopy to confirm the position and extraction if safe. AEF occurs with time and could result in massive haemorrhage and mediastinitis. Endoscopic stenting, thoracoscopic surgery, and open repair are methods of emergent and definite management that still carry significant mortality. CONCLUSION Management of AEF requires early diagnosis with a high index of suspicion, endoscopic and CT-based angiography studies, and surgical interventions tailored to patients based on the available expertise. High-risk patients should be similarly educated on the probable complications and the symptomatology.
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Affiliation(s)
| | | | - B M Munasinghe
- Department of Anaesthesiology and Intensive Care, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK.
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13
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Donato F, Boskoski I, Vincenzoni C, Montanari F, Tinelli G, Donati T, Tshomba Y. A New Mini-Invasive Approach for a Catastrophic Disease: Staged Endovascular and Endoscopic Treatment of Aorto-Esophageal Fistulas. J Pers Med 2022; 12:1735. [PMID: 36294876 PMCID: PMC9605668 DOI: 10.3390/jpm12101735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/01/2022] [Accepted: 10/18/2022] [Indexed: 08/10/2023] Open
Abstract
Aorto-esophageal fistula (AEF) is an uncommon but usually fatal disorder. Surgery with resection of an aneurysm and esophagus, in situ reconstruction of the descending aorta and omental flap installation offers the gold standard for the reduction of infections, but it is burdened by high intraoperative and perioperative mortality rates. We report our experience with a combined minimally invasive approach for the multi-stage treatment of three cases of aorto-esophageal fistula caused by thoracic aneurysm rupture. In all of the patients, the aneurysm was treated with thoracic endovascular aortic repair and the esophageal lesion was treated with esophageal endoprosthesis placement. According to our experience, the combined strategy of thoracic endovascular aortic repair (TEVAR) and esophageal less invasive endoscopic treatments represents an alternative solution in frail patients with high surgical risk.
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Affiliation(s)
- Federica Donato
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ivo Boskoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Claudio Vincenzoni
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesca Montanari
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanni Tinelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Tommaso Donati
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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14
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One-stage operation for aortoesophageal fistula. JTCVS Tech 2022; 16:11-13. [PMID: 36510556 PMCID: PMC9735358 DOI: 10.1016/j.xjtc.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/19/2022] [Accepted: 09/01/2022] [Indexed: 12/16/2022] Open
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15
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Dai SY, Chang CH, Wang YC, Wen JS, Liao TK, Lin WT, Chan RH, Tsai MT, Huang WL. Three-stage approach for aortoesophageal fistula after Roux-en-Y esophagojejunostomy. Thorac Cancer 2022; 13:1744-1746. [PMID: 35470568 PMCID: PMC9161312 DOI: 10.1111/1759-7714.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022] Open
Abstract
Surgical management of post‐esophagojejunostomy aortoesophageal fistula (AEF) has been scarcely reported, but is universally fatal. This report described a case of AEF after total gastrectomy with Roux‐en‐Y esophagojejunostomy and adjuvant chemoradiotherapy for gastric cardiac cancer. A three‐stage hybrid approach was used to successfully manage this complication. First, thoracic endovascular aortic repair curbed bleeding. Second, radical fistula resection eradicated infected areas and adjacent structures. Third, esophageal reconstruction using an ileocolonic conduit restored gastrointestinal continuity. This strategy could be safely feasible for managing post‐esophagojejunostomy AEF.
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Affiliation(s)
- Shuo-Ying Dai
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Hao Chang
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Chen Wang
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jih-Sheng Wen
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ting-Kai Liao
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ting Lin
- Division of Colorectal Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ren-Hao Chan
- Division of Colorectal Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Meng-Ta Tsai
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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16
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Gong H, Wei W, Huang Z, Hu Y, Liu XL, Hu Z. Endovascular stent-graft treatment for aortoesophageal fistula induced by an esophageal fishbone: Two cases report. World J Clin Cases 2022; 10:2206-2215. [PMID: 35321176 PMCID: PMC8895182 DOI: 10.12998/wjcc.v10.i7.2206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/21/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) induced by esophageal fishbones is a rare complication of esophageal foreign bodies and is very difficult to treat. Although the current view suggests that endovascular stent-graft treatment is useful for AEF, whether a subsequent thoracic operation is necessary remains controversial. The purpose of this report is to describe our experience using endovascular stent-graft treatment without combined thoracic operations for the treatment of AEF in two specific cases.
CASE SUMMARY We presented two cases of patients complaining of retrosternal discomfort treated in our department for an aortoesophageal fistula caused by the accidental ingestion of a fishbone. The two patients were effectively managed with combined means of endoscopic, medical (broad-spectrum antibiotic therapy, fasting, gastrointestinal decompression, etc.) and endovascular stent-graft treatment. The main difference in treatment was that the first patient presented with hematemesis after endoscopic removal of the fishbone. Subsequently, the patient underwent endovascular stent-graft treatment. The second case was managed with endoscopic removal of the fishbone with simultaneous endovascular stent-graft treatment, without any signs of hematemesis or melena. Both patients had successful postoperative management and were discharged home. Long-term follow-up is ongoing.
CONCLUSION The treatment decision-making process should depend on the patients’ specific situations. Our practice indicates that endovascular stent-graft treatment without combined thoracic operations could be a valuable alternative in selected patients.
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Affiliation(s)
- Hang Gong
- Department of Gastroenterology, Zigong First People's Hospital, Zigong 643000, Sichuan Province, China
| | - Wei Wei
- Department of Gastroenterology, Zigong First People's Hospital, Zigong 643000, Sichuan Province, China
| | - Zhong Huang
- Department of Gastroenterology, Zigong First People's Hospital, Zigong 643000, Sichuan Province, China
| | - Ying Hu
- Department of Gastroenterology, Luzhou People's Hospital, Luzhou 646000, Sichuan Province, China
| | - Xian-Li Liu
- Department of Ultrasound, Zigong TCM Hospital, Zigong 643000, Sichuan Province, China
| | - Zhen Hu
- Department of Gastroenterology, Zigong First People's Hospital, Zigong 643000, Sichuan Province, China
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17
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Wang C, Lei L, Zhang W, Fan X. An aorto-oesophageal fistula treated with total arch repair combined with oesophageal repair. Interact Cardiovasc Thorac Surg 2021; 33:145-147. [PMID: 33585927 DOI: 10.1093/icvts/ivab038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/21/2020] [Accepted: 01/21/2021] [Indexed: 12/15/2022] Open
Abstract
Aorto-oesophageal fistula is a rare but fatal disease. Open surgical repair or endotube repair of aorta and oesophagus save patients from circulatory deterioration, major haematemesis and severe infection. Here we present a rare case of an aorto-oesophageal fistula in the right hemi-arch caused by a fish bone treated with an alternative surgical strategy. Total aortic arch repair using the frozen elephant trunk procedure combined with oesophageal repair were performed. No aortic fistula, oesophageal fistula or artificial graft infection occurred in the follow-up.
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Affiliation(s)
- Chaojie Wang
- Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Liming Lei
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Wenqian Zhang
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaoping Fan
- Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
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18
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Isagawa Y, Kanetaka K, Yoneda A, Matsumaru I, Miura T, Eishi K, Eguchi S. Thoracoscopy-thoracotomy approach for an aortoesophageal fistula: a case report. Gen Thorac Cardiovasc Surg 2020; 69:168-171. [PMID: 33237444 DOI: 10.1007/s11748-020-01553-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/02/2020] [Indexed: 10/22/2022]
Abstract
An aortoesophageal fistula is often fatal, and standard radical surgery is highly invasive because both bilateral thoracotomy and laparotomy are required. We successfully incorporated thoracoscopic esophagectomy into this procedure for a 43-year-old man with an aortoesophageal fistula. After detaching the esophagus from the adjacent tissue, and leaving just the fistula in the right thoracoscopic procedure, we performed an open aortic graft replacement. Subsequently, we created an omental pedicle graft and wrapped it over the graft. Through this thoracoscopy-thoracostomy approach, minimal destruction of the right thoracic wall was achieved and the successful dissection of the diseased esophagus could be carried out while reducing the amount of bleeding during anticoagulation for cardiopulmonary bypass, and the field of view for the aortic replacement was not disturbed during left thoracotomy. Four months later, we reconstructed the esophagus by a pedunculated small intestinal graft through the ante-thoracic route. A thoracoscopy-thoracotomy approach is therefore considered to be effective and useful for treating a patient with an aortoesophageal fistula.
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Affiliation(s)
- Yuriko Isagawa
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528501, Japan
| | - Kengo Kanetaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528501, Japan.
| | - Akira Yoneda
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528501, Japan
| | - Ichiro Matsumaru
- Department of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528501, Japan
| | - Takashi Miura
- Department of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528501, Japan
| | - Kiyoyuki Eishi
- Department of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528501, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528501, Japan
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19
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Sugiyama K, Iwahashi T, Koizumi N, Nishibe T, Fujiyoshi T, Ogino H. Surgical treatment for secondary aortoesophageal fistula. J Cardiothorac Surg 2020; 15:251. [PMID: 32917262 PMCID: PMC7488492 DOI: 10.1186/s13019-020-01293-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background Aortoesophageal fistula (AEF) is a relatively rare condition that is often life-threatening. Secondary AEF is a complication of previous surgery, which can be more critical and challenging than primary AEF. The number of secondary AEF is increasing due to increase in the number of thoracic endovascular aortic repair (TEVAR). Although TEVAR has become a successful alternative surgical strategy for thoracic aortic aneurysms, secondary AEF after TEVAR might be critical than other secondary AEF because of severe adhesion between the esophagus and residual thoracic aortic wall. Methods This study analyzed six patients with secondary AEF who were treated at Tokyo Medical University Hospital between 2011 and 2016. These participants included four patients who had undergone TEVAR and two who had undergone total arch replacement. Results Although they were subsequently hospitalized for a long period, open surgical repair was completed in two patients who had undergone total arch replacement. TEVAR alone was performed in two patients who had undergone TEVAR and they were discharged without major complications shortly. Combined repair of TEVAR as a bridge to open surgery was planned for two patients who had undergone TEVAR. However, reconstruction of the aorta and esophagus could not be completed in these patients due to severe adhesions, and they died during hospitalization. Conclusions Definitive open repair was successfully performed in patients with secondary AEF after total arch replacement. However, in the patients with secondary AEF after TEVAR, severe adhesion between the aorta and esophagus led to difficulty in performing a successful definitive open repair. The strategy for secondary AEF should, therefore, be decided considering the etiology of secondary AEF. In secondary AEF after TEVAR, definitive open repair is difficult to complete because of catastrophic complication, and palliative treatment using TEVAR without reconstruction of aorta and esophagus can be an alternative.
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Affiliation(s)
- Kayo Sugiyama
- Department of Cardiac Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Nobusato Koizumi
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Toshiki Fujiyoshi
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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20
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Anciano CJ, Iannettoni MD. Commentary: Aortoesophageal fistulas for 500: What is Monday morning quarterbacking? J Thorac Cardiovasc Surg 2020; 163:2010-2011. [PMID: 32800369 DOI: 10.1016/j.jtcvs.2020.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Carlos J Anciano
- Division of Thoracic and Foregut Surgery, East Carolina University, Greenville, NC.
| | - Mark D Iannettoni
- Division of Thoracic and Foregut Surgery, East Carolina University, Greenville, NC
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21
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Shlomin VV, Nokhrin AV, Orzheshkovskaia IE, Bova VI, Nefedov AV, Mikhaĭlov IV, Bondarenko PB, Puzdriak PD, Dmitrievskaia NO. [Surgical treatment of a patient with traumatic rupture of the aortic arch and late oesophageal perforation]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:175-182. [PMID: 32597900 DOI: 10.33529/angio2020219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Described herein is a clinical case report regarding a patient presenting with traumatic rupture of the aortic isthmus with the development of a pseudoaneurysm occupying virtually the entire posterior mediastinum and measuring 20?10 cm in size. He was immediately treated as an emergency to undergo prosthetic reconstruction of the portion of the aortic arch and descending thoracic aorta by means of temporary bypass grafting with a synthetic graft in order to protect the visceral organs. The postoperative period was complicated by oesophageal perforation with the formation of an oesophago-paraprosthetic fistula, infection of the vascular graft, accompanied by the development of pleural empyema and mediastinitis. A second operative procedure was performed, consisting of subclavian-iliac bypass grafting on the right with a polytetrafluoroethylene graft measuring 20 mm in diameter, exclusion of the intrathoracic portion of the oesophagus, creation of a gastro- and oesophagostoma, retrieval of the vascular graft followed by suturing of the aorta, pleurectomy, decortication of the lung, and removal of the empyemic sac on the left. There was no evidence of ischaemia of the spinal cord or visceral arteries. One month postoperatively, he underwent a traumatological stage and 4 months thereafter plasty of the oesophagus with an isoperistaltic gastric pedicle, extirpation of the thoracic portion of the oesophagus, to be later on followed by closure of the oesophagostoma. The patient experienced no difficulties either while walking or during other physical activities, with the ankle-brachial index amounting to 0.9. With time, he developed difficult-to-correct pulmonary hypertension. Unfortunately, the patient eventually died of acute cardiopulmonary insufficiency 9 years after right-sided extra-anatomical subclavian-iliac bypass grafting.
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Affiliation(s)
- V V Shlomin
- Department of Vascular Surgery, Municipal Multimodality Hospital #2, Saint Petersburg, Russia
| | - A V Nokhrin
- Department of Vascular Surgery, Municipal Multimodality Hospital #2, Saint Petersburg, Russia
| | - I E Orzheshkovskaia
- Department of Vascular Surgery, Municipal Multimodality Hospital #2, Saint Petersburg, Russia
| | - V I Bova
- Department of Vascular Surgery, Municipal Multimodality Hospital #2, Saint Petersburg, Russia
| | - A V Nefedov
- Department of Vascular Surgery, Municipal Multimodality Hospital #2, Saint Petersburg, Russia
| | - I V Mikhaĭlov
- Department of Vascular Surgery, Municipal Multimodality Hospital #2, Saint Petersburg, Russia
| | - P B Bondarenko
- National Medical Research Centre named after V.A. Almazov under the RF Ministry of Public Health, Saint Petersburg, Russia
| | - P D Puzdriak
- Department of Vascular Surgery, Municipal Multimodality Hospital #2, Saint Petersburg, Russia
| | - N O Dmitrievskaia
- Department of Vascular Surgery, Municipal Multimodality Hospital #2, Saint Petersburg, Russia
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22
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Repair of aortoesophageal fistula with homograft aortic replacement and primary esophageal closure. J Thorac Cardiovasc Surg 2020; 163:2002-2008. [PMID: 32921442 DOI: 10.1016/j.jtcvs.2020.06.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/04/2020] [Accepted: 06/15/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The presence of a fistula between the thoracic aorta and the esophagus is a rare and highly fatal condition. This study aimed to evaluate the outcomes of the surgical treatment of an aortoesophageal fistula (AEF). METHODS We retrospectively reviewed patients with AEF who underwent surgery at our institution. RESULTS Between 2007 and 2018, a total of 10 patients who underwent surgery for AEF. The mean age was 63 ± 12 years, and 6 patients were men. Four patients had primary AEFs and 6 patients had secondary AEFs (3 graft replacements and 3 thoracic endovascular aortic repairs). The timing of AEF since graft replacement or thoracic endovascular aortic repairs was 21.6 ± 27 days. We performed aortic replacement with a prosthetic graft (4 patients) or a homograft (5 patients) and extra-anatomical bypass due to a previous aortic graft infection (1 patient). As a treatment of the esophagus, we conducted primary repair in 7 of 10 patients. The median lengths of hospital and intensive care unit stay were 59 days (range, 9-225 days) and 6.3 days (range, 1-87 days), respectively. Seven patients achieved oral feeding after a median 10.3 postoperative days (range, 7-78 postoperative days). Two of the 10 patients died of sepsis at 9 and 74 days postoperatively. CONCLUSIONS The strategy for patients with AEF should be individualized. Our surgical strategy for AEF, which includes simultaneous aortic graft replacement and primary repair of esophagus in the same operative field, is feasible and promising.
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23
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Pahwa S, Bhattacharya S, Mukhopadhyay S, Verma A. Aorto-esophageal fistula: successful open surgical management of two cases. J Surg Case Rep 2020; 2020:rjaa114. [PMID: 32582430 PMCID: PMC7299603 DOI: 10.1093/jscr/rjaa114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 03/27/2020] [Accepted: 04/07/2020] [Indexed: 11/13/2022] Open
Abstract
An aorto-esophageal fistula (AEF) is a rare yet life-threatening cause of upper gastrointestinal bleeding. We report our experience with open surgical management of two cases of AEF. Both cases presented with almost identical presentations: hematemesis and hemodynamic instability. The aorta in the first patient was normal; the defect was small and was repaired with a Dacron patch. The second patient had an aneurysmal aorta, which was replaced with a Dacron graft. Both cases were performed under partial bypass. The esophageal rent in both patients was debrided, primarily closed and buttressed with a vascularized intercostal pedicle. Nonavailability of endovascular personnel and equipment along with hemodynamic instability of the patient influenced our surgical strategy. Long-term follow-up of these patients is necessary to analyze the outcomes of our surgical repair.
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Affiliation(s)
- Siddharth Pahwa
- Department of Cardiovascular Surgery, Mayo Clinic, 200 1st Street, Rochester, MN 55905, USA
| | - Susmit Bhattacharya
- Department of Cardiovascular Surgery, AMRI Hospitals, 16 and 17 JC Block, Bidhannagar, Salt Lake, Kolkata 700098, West Bengal, India
| | - Siddhartha Mukhopadhyay
- Department of Cardiovascular Surgery, AMRI Hospitals, 16 and 17 JC Block, Bidhannagar, Salt Lake, Kolkata 700098, West Bengal, India
| | - Ashok Verma
- Department of Cardiac Anesthesia, AMRI Hospitals, 16 and 17 JC Block, Bidhannagar, Salt Lake, Kolkata 700098, West Bengal, India
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24
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Guerrero I, Cuenca JA, Cardenas YR, Nates JL. Hemorrhagic Shock Secondary to Aortoesophageal Fistula as a Complication of Esophageal Cancer. Cureus 2020; 12:e7146. [PMID: 32257691 PMCID: PMC7105269 DOI: 10.7759/cureus.7146] [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] [Indexed: 12/14/2022] Open
Abstract
Although aortoesophageal fistulas are rare, they can present as life-threatening emergencies. This condition can develop secondary to an aneurysm, foreign bodies, infiltrating tumors, and radiotherapy. We report a patient with hemorrhagic shock secondary to an aortoesophageal fistula. A 69-year-old male with squamous cell carcinoma of the esophagus treated with chemoradiation and metallic stent placement was admitted to the intensive care unit (ICU) after an episode of hematemesis. The patient was hemodynamically unstable, requiring fluid resuscitation, blood transfusions, and respiratory and vasopressor support. The patient developed electric pulseless activity, and cardiopulmonary resuscitation was performed for 40 minutes. An upper endoscopy showed the esophageal tumor infiltrating into the stent, and computed tomography (CT) angiogram showed leakage of contrast from the thoracic aorta to the esophagus. The diagnosis of aortoesophageal fistula was made. The patient underwent endovascular management for the fistula. However, his critical condition did not improve, and the patient perished.
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Affiliation(s)
- Ivan Guerrero
- Department of Surgery, San Ignacio Hospital-Pontificia Universidad Javeriana, Bogota, COL
| | - John A Cuenca
- Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Yenny R Cardenas
- Department of Critical and Intensive Care, Hospital Universitario Fundación Santa Fe De Bogotá, Bogota, COL
| | - Joseph L Nates
- Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, USA
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Zhan Y, Xu Z. Massive hemorrhage from an aortoesophageal fistula caused by esophageal stent implantation: A case report and literature review. Medicine (Baltimore) 2019; 98:e18303. [PMID: 31860979 PMCID: PMC6940160 DOI: 10.1097/md.0000000000018303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
RATIONALE Aortoesophageal fistula (AEF) is the direct communication between the aorta and esophagus, which can cause fatal hemorrhage, and its incidence increased with the use of an esophageal stent (ES). PATIENT CONCERNS A 79-year-old man was admitted due to hemodynamic shock with massive hematemesis caused by AEF 1 month after the implantation of an ES. DIAGNOSES Computed tomography angiography visualized an AEF with an ulcer-like projection on the aortic arch where the ES was placed. Angiography of the aorta revealed extravasation of contrast media from the aortic arch into the stented esophagus, which confirmed the diagnosis. INTERVENTIONS Thoracic endovascular aortic repair (TEVAR) was performed for massive hematemesis caused by ES-related, AEF but did not solve the underlying problem, leading to the second fatal hemorrhage. LESSONS TEVAR for the unique treatment of ES-related AEF is feasible in certain cases but may lead to collapse after a specific period.
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Kamigaichi A, Hamai Y, Emi M, Ibuki Y, Takahashi S, Katayama K, Furukawa T, Okada M. Three-step surgical treatment of aortoesophageal fistula after thoracic endovascular aortic repair: A case report. Int J Surg Case Rep 2019; 65:221-224. [PMID: 31733619 PMCID: PMC6864132 DOI: 10.1016/j.ijscr.2019.10.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/28/2019] [Accepted: 10/26/2019] [Indexed: 11/18/2022] Open
Abstract
The number of aortoesophageal fistula (AEF) after thoracic endovascular aortic repair (TEVAR) is recently increasing due to the spread of TEVAR. AEF is a rare but fatal disease, and only surgery can save the life of patients with AEF after TEVAR. The therapeutic strategy for AEF after TEVAR remains controversial. The three-step surgical approach described herein could be a useful therapeutic option for AEF after TEVAR.
Introduction Aortoesophageal fistula (AEF) is a fatal complication results in sudden massive hematemesis. Although thoracic endovascular aortic repair (TEVAR) is an established method of treating aortic aneurysms or aortic dissection, the number of AEF after TEVAR is recently increasing due to the spread of TEVAR. However, the therapeutic strategy for AEF remains controversial. Presentation of case We describe a 71-year-old man with Stanford B aortic dissection and aortic aneurysm rupture treated by TEVAR who developed AEF between the thoracic aorta and upper thoracic esophagus 20 months thereafter. We applied a three-step surgical procedure for this patient comprising resection of the esophagus as the infectious source, removal of an aortic aneurysm with stent-graft and replacement of the aorta, and final reconstruction of the esophagus. Thereafter, the patient resumed oral intake and has remained relapse-free for 24 months without adverse events. Discussion Previous reports have described simultaneous resection of the esophagus and aortic stent-graft via a left thoracotomy followed by a two-step surgical reconstruction of the esophagus. We applied a three-step procedure consisting of resections of the esophagus and aortic stent-graft on separate occasions followed by esophageal reconstruction in this patient. The first procedure in the three-step approach is less stressful than that of the two-step approach. Conclusion The three-step surgical approach to treating AEF after TEVAR resulted in a good outcome for this patient. Thus, this surgical strategy is a useful option for treating AEF after TEVAR.
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Affiliation(s)
| | - Yoichi Hamai
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
| | - Manabu Emi
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yuta Ibuki
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Graduate School of Medicine, Hiroshima University, Hiroshima, Japan
| | - Keijiro Katayama
- Department of Cardiovascular Surgery, Graduate School of Medicine, Hiroshima University, Hiroshima, Japan
| | - Tomokuni Furukawa
- Cardiovascular Center, Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
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Preliminary Experience with Prophylactic Thoracic Endovascular Aortic Repair in Patients Affected by Advanced Esophageal Cancer. Ann Vasc Surg 2019; 61:142-147. [PMID: 31394222 DOI: 10.1016/j.avsg.2019.05.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 12/15/2022]
Abstract
Bleeding from the thoracic aorta is potentially fatal in patients with advanced esophageal cancer (AEC). Esophageal malignancy is the third most common cause of aortoesophageal fistula, after thoracic aortic aneurysm and ingestion of foreign body. The involvement of aortic wall often contraindicates chemoradiotherapy (CRT) treatment, thus reducing life expectancy of these patients. Thoracic endovascular aortic repair (TEVAR) is a well-described mini-invasive technique that can be also applied for coverage of the aortic lumen in case of invasion by esophageal cancer. Only few cases have been published with this atypical indication. Between 2016 and 2018, in our tertiary hospital 3 patients affected by AEC involving the thoracic aorta were treated by means of prophylactic TEVAR. All procedures were uneventful, and all patients were reconsidered fit for preoperative or definitive CRT.
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Helmedag MJ, Eickhoff R, Lambertz A, Heise D, Grommes J, Jacobs M, Neumann UP, Klink C. First Result of a Tailored Progressive Multistep Approach for the Treatment of Aorto-esophageal Fistulae. Thorac Cardiovasc Surg 2019; 69:223-227. [PMID: 31307099 DOI: 10.1055/s-0039-1692659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Aorto-esophageal fistulae (AEFs) are a rare but serious and life-threatening disease of the mediastinum. Especially, AEF in the presence of infected stent grafts, for example, after thoracic endovascular aortic repair (TEVAR) is only curable by a multistage interdisciplinary surgical approach. This study presents the results of our four-stage approach consisting of bridging TEVAR, esophagectomy, complete stent removal followed by total bovine tube aortic replacement (TBTAR), and finally esophageal reconstruction. METHODS A case series of four patients from our department receiving a four-stage treatment of AEF is presented in this study. Retrospective database analysis focusing on overall survival, duration of intensive care unit and total hospital stay until discharge, complications, surgical time frame, and completion of chosen surgical treatment course was performed. RESULTS Overall, four patients surgically treated for AEF since May 2015 were included. A 30-day mortality was 0%, and overall survival at 1 year was 75%. All patients survived more than 5 months and could be discharged after TEVAR and esophagectomy. TBTAR could be performed in two of four patients (50%). Esophageal reconstruction was completed in all patients. Average follow-up was 20.3 ± 1.7 months or until death. CONCLUSION The acute management of AEF using this approach seems satisfactory, especially for reducing acute short-term mortality. Complete restoration of the circulatory system and digestive tract remains challenging and is associated with high morbidity. We support the application of bridging TEVAR with a staggered approach to further surgical treatment individually tailored to the patient.
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Affiliation(s)
- Marius Julian Helmedag
- Department of General-, Visceral- and Transplantation Surgery, Universitatsklinikum Aachen, Aachen, Germany
| | - Roman Eickhoff
- Department of General-, Visceral- and Transplantation Surgery, Universitatsklinikum Aachen, Aachen, Germany
| | - Andreas Lambertz
- Department of General-, Visceral- and Transplantation Surgery, Universitatsklinikum Aachen, Aachen, Germany
| | - Daniel Heise
- Department of General-, Visceral- and Transplantation Surgery, Universitatsklinikum Aachen, Aachen, Germany
| | - Jochen Grommes
- Department of Vascular Surgery, European Vascular Center, Universitatsklinikum Aachen, Aachen, Germany
| | - Michael Jacobs
- Department of Vascular Surgery, European Vascular Center, Universitatsklinikum Aachen, Aachen, Germany
| | - Ulf Peter Neumann
- Department of General-, Visceral- and Transplantation Surgery, Universitatsklinikum Aachen, Aachen, Germany
| | - Christian Klink
- Department of General-, Visceral- and Transplantation Surgery, Universitatsklinikum Aachen, Aachen, Germany
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Thoracic Endovascular Aortic Repair of Esophageal Cancer-Associated Aortoesophageal Fistula: A Case Report and Literature Review. Case Rep Oncol Med 2018; 2018:9851397. [PMID: 30662781 PMCID: PMC6313998 DOI: 10.1155/2018/9851397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/26/2018] [Indexed: 12/15/2022] Open
Abstract
Background Thoracic endovascular aortic repair of an aortoesophageal fistula is an effective emergency treatment for patients with T4-esophageal cancer, as it prevents sudden death, and is a bridge to surgery. However, the course of unresectable malignant aortoesophageal fistula treated with thoracic endovascular aortic repair alone is not well-known. Case Presentation We report a 67-year-old Japanese man with T4-esophageal cancer who experienced a chemoradiation-induced aortoesophageal fistula and was rescued with thoracic endovascular aortic repair. He recovered after the procedure and survived for 4 additional months with management of a mycotic aneurysm and secondary aortoesophageal fistula with the exposure of the stent graft into the esophagus. Thoracic endovascular aortic repair of aortoesophageal fistula with T4-esophageal cancer extended life for nearly an average of 4 months in the reported cases. As a postoperative complication, the exposure of the stent graft into the esophagus is rare but life-threatening; the esophageal stent insertion was effective. Conclusions With postoperative management advances, thoracic endovascular aortic repair can improve survival and increase the quality of life of patients with T4-esophageal cancer.
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Abstract
Vascular graft infection is a devastating complication of vascular reconstructive surgery. The infection can occur early in the postoperative period and is largely due to intraoperative contamination or by contiguous extension from a nearby infection. It can also occur years after implantation. Staphylococci remain the most common organisms and biofilm production makes eradication difficult. Factors commonly reported to predispose to vascular graft infection are periodontal disease, nasal colonization with Staphylococcus aureus, bacteremia, certain graft characteristics, diabetes mellitus, postoperative hyperglycemia, location of the incision, wound infection, and emergency procedure. Management consists of antibiotic and surgical therapy. Preventive methods are described.
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Affiliation(s)
- Amal Gharamti
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut, Cairo Street, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Zeina A Kanafani
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut, Cairo Street, Riad El Solh, Beirut 1107 2020, Lebanon; Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Cairo Street, PO Box 11-0236/11D, Riad El Solh, Beirut 1107 2020, Lebanon.
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Nakajima M, Muroi H, Kikuchi M, Yamaguchi S, Sasaki K, Tsuchioka T, Takei Y, Shibasaki I, Fukuda H, Kato H. Salvage esophagectomy combined with partial aortic wall resection following thoracic endovascular aortic repair. Gen Thorac Cardiovasc Surg 2018; 66:736-743. [DOI: 10.1007/s11748-018-1013-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/08/2018] [Indexed: 02/08/2023]
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Kotelis D, Gombert A, Jacobs MJ. Treatment of post-thoracic endovascular aortic repair aorto-esophageal fistula-only radical surgery can be effective: techniques and sequence of treatment. J Thorac Dis 2018; 10:3869-3873. [PMID: 30069387 DOI: 10.21037/jtd.2018.06.25] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aorto-esophageal fistulas (AEFs) are rare after thoracic endovascular aortic repair (TEVAR), being associated with the presence of mediastinal hematoma and the need for emergency TEVAR. Left untreated, AEFs are always lethal. "Redo"-stent-grafting can serve as a "bridging" procedure in hemodynamically unstable patients, but is not a durable therapy. Radical surgery is shown to be the most durable and effective treatment. This includes esophagectomy, stent-graft removal and aortic replacement followed by esophageal reconstruction, e.g., gastric pull-up operation. Aortic reconstruction can be performed by the use of self-made bovine pericardial tubes. A bilateral anterior ("clam-shell") thoracotomy can be chosen for surgical exposure in revision cases after previous sternotomy, in which the ascending aorta, aortic arch and proximal descending aorta require reconstruction.
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Affiliation(s)
- Drosos Kotelis
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Alexander Gombert
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael J Jacobs
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Shen JY, Zhang HW, Fan KJ, Liao H, Zhang EY, Hu J. Aortoesophageal fistula and arch pseudoaneurysm after removing of a swallowed chicken bone: a case report of one-stage hybrid treatment. BMC Surg 2018; 18:3. [PMID: 29325526 PMCID: PMC5765606 DOI: 10.1186/s12893-018-0335-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/02/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) and arch pseudoaneurysm are rare complications induced by a foreign body, and considerable controversy remains regarding the appropriate management strategies. We herein report a successful one-stage hybrid treatment in a patient with AEF and arch pseudoaneurysm. CASE PRESENTATION The patient, a 40-year-old man, presented to the emergency room because of intense retrosternal discomfort for 3 days and hematemesis for 3 h. The esophagoscopy and thoracic enhanced computed tomography (CT) showed two irregular mural ulcers in the esophagus and a large saccular pseudoaneurysm at the aortic isthmus, respectively. The laboratory examinations confirmed no widespread inflammation and infection. We have successfully performed a successful one-stage hybrid treatment for this patient. Six-month follow-up shows the patient is in good condition and the esophagoscopy reveals the two mural ulcers had completely healed. CONCLUSION The treatment decision-making process should depend upon the patients' specific situations. Our case suggest the one-stage hybrid treatment could be an valuable alternative in some selected patients.
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Affiliation(s)
- Jia-Yu Shen
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Guo Xue Alley 37#, Chengdu, 610041, People's Republic of China
| | - Hong-Wei Zhang
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Guo Xue Alley 37#, Chengdu, 610041, People's Republic of China
| | - Kang-Jun Fan
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Guo Xue Alley 37#, Chengdu, 610041, People's Republic of China
| | - Hu Liao
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Guo Xue Alley 37#, Chengdu, 610041, China
| | - Er-Yong Zhang
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Guo Xue Alley 37#, Chengdu, 610041, People's Republic of China
| | - Jia Hu
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Guo Xue Alley 37#, Chengdu, 610041, People's Republic of China.
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Yamazato T, Nakamura T, Abe N, Yokawa K, Ikeno Y, Koda Y, Henmi S, Nakai H, Gotake Y, Matsueda T, Inoue T, Tanaka H, Kakeji Y, Okita Y. Surgical strategy for the treatment of aortoesophageal fistula. J Thorac Cardiovasc Surg 2018; 155:32-40. [DOI: 10.1016/j.jtcvs.2017.09.047] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/24/2017] [Accepted: 09/09/2017] [Indexed: 02/08/2023]
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Matsumoto A, Kanaoka Y, Baba T, Takizawa R, Hara M, Maeda K, Nishikawa K, Suzuki Y, Yanaga K, Ohki T. Result of Thoracic Endovascular Aortic Repair for Patients with Esophageal Cancer. World J Surg 2017; 42:1551-1558. [PMID: 29167953 DOI: 10.1007/s00268-017-4334-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bleeding from the thoracic aorta is potentially fatal in patients with advanced esophageal cancer. Thoracic endovascular aortic repair (TEVAR) was recently applied for aortic invasion by esophageal cancer. However, only a few case reports have been published. This study was performed to clarify the effectiveness and safety of TEVAR for patients with advanced esophageal cancer. METHODS We retrospectively reviewed 18 patients who underwent TEVAR for esophageal cancer. We also performed a literature search and reviewed 21 similar cases. RESULTS From 2007 to 2016, 10 patients were treated on an emergent basis for aortic hemorrhage (salvage group) and 8 patients underwent urgent prophylactic surgery (prophylactic group). Hemostasis was achieved in all cases. One (10%) patient in the salvage group died of aspiration pneumonia on postoperative day 1, while all patients in the prophylactic group survived for >1 month. The median survival period in the salvage and prophylactic group was 3.25 and 11.10 months, respectively. The longest survivor was still alive 9 years after TEVAR and chemoradiotherapy. No fatal adverse events or negative impacts on subsequent treatment for esophageal cancer occurred. CONCLUSIONS TEVAR is feasible, safe, and effective in preventing fatal aortic hemorrhage secondary to esophageal cancer invasion, although it is palliative in most cases. Because the outcomes of emergent TEVAR after bleeding tended to be worse in the salvage than in prophylactic group, prophylactic TEVAR may be considered a viable treatment option for patients with aortic invasion by advanced esophageal cancer.
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Affiliation(s)
- Akira Matsumoto
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Yuji Kanaoka
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Takeshi Baba
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Reo Takizawa
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Masayuki Hara
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Koji Maeda
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Katsunori Nishikawa
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Takao Ohki
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8471, Japan.
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Nakamura T, Yamamoto M, Yamazato T, Kanaji S, Takahashi H, Inoue T, Oshikiri T, Tanaka H, Suzuki S, Okita Y, Kakeji Y. Surgical strategy of esophageal resection and reconstruction for aortoesophageal fistula. Dis Esophagus 2017; 30:1-7. [PMID: 28859368 DOI: 10.1093/dote/dox077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/26/2017] [Indexed: 12/11/2022]
Abstract
Aortoesophageal fistula is a critical and life-threatening disease. The cardiovascular strategy for graft replacement has been widely discussed. However, the surgical strategy of esophageal resection and reconstruction for aortoesophageal fistula has rarely been discussed. The objective of this study is to establish a surgical strategy and procedure of esophageal resection and reconstruction for aortoesophageal fistula. Eleven patients with aortoesophageal fistula who underwent aortic graft replacement and esophagectomy between 2008 and 2015 at Kobe University Hospital were enrolled in this study. Patient characteristics, operative methods, and clinical outcomes were obtained by retrospective chart review. All 11 patients underwent graft replacement, esophagectomy, and omental wrapping. Ten esophagectomies were simultaneously accomplished in the same operative field as aortic graft replacement. Seven patients underwent subtotal esophagectomy from a left thoracotomy, and three patients underwent upper hemiesophagectomy from a median sternotomy. The other patient underwent staged esophagectomy from a right thoracotomy. Seven of 11 patients (63.6%) successfully underwent staged esophageal reconstruction. Pedicled jejunal transfer with supercharge and superdrainage were performed in six patients, and ileocecal reconstruction was performed in one patient. Median survival time in the patients with esophageal reconstruction was 21 months while that in the patients without esophageal reconstruction was 10 months. Six of 7 patients (85.7%) who underwent esophageal reconstructions were alive. Our surgical strategy for aortoesophageal fistula, which includes simultaneous graft replacement and esophagectomy in the same operative field and staged reconstruction by pedicled jejunal transfer to ensure omental wrapping, is feasible and promising.
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Affiliation(s)
| | | | - T Yamazato
- Department of Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan.,Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe
| | - S Kanaji
- Division of Gastrointestinal Surgery
| | - H Takahashi
- Department of Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - T Inoue
- Department of Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | | | - H Tanaka
- Department of Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - S Suzuki
- Division of Gastrointestinal Surgery
| | - Y Okita
- Department of Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - Y Kakeji
- Division of Gastrointestinal Surgery
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Uno K, Koike T, Takahashi S, Komazawa D, Shimosegawa T. Management of aorto-esophageal fistula secondary after thoracic endovascular aortic repair: a review of literature. Clin J Gastroenterol 2017; 10:393-402. [PMID: 28766283 DOI: 10.1007/s12328-017-0762-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 07/06/2017] [Indexed: 12/15/2022]
Abstract
Aorto-esophageal fistula (AEF) is a rare and lethal entity, and the difficulty of making diagnosis of AEF is well-known. As promising results in the short-term effectiveness of thoracic endovascular aortic repair (TEVAR) promote its usage, the occurrence of AEF after TEVAR (post-TEVAR AEF) increases as one of the major complications. Therefore, we provide a review concerning the management strategy of post-TEVAR AEF. Although its representative symptom was reported as the triad of mid-thoracic pain and sentinel hematemesis followed by massive hematemesis, the symptom-free interval between sentinel hemorrhage and massive exsanguination is unpredictable. However, the physiological condition represents a surgical contraindication. Accordingly, early diagnosis is important, but either CT or esophago-gastro-duodenoscopy rarely depicts a typical image. The formation of post-TEVAR AEF might be associated with the infection of micro-organisms, which is uncontrollable with anti-biotic administration. The current first-line strategy is combination therapy as follows, (1) to control bleeding by TEVAR in the urgent phase, and (2) radical debridement and aortic/esophageal re-construction in the semi-urgent phase. In view of the high mortality and morbidity rate, it is proposed that the choice in treatment strategies might be affected by patient`s condition, size of the wall defects and the etiology of AEF. Practically, we should keep in mind the importance of making an early diagnosis and, once a suspicious symptom has occurred in a patient with a history of TEVAR, the existence of post-TEVAR AEF should be suspected. A prospective registry together with more developed technologies will be needed to establish a future strategy.
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Affiliation(s)
- Kaname Uno
- Division of Gastroenterology, Tohoku University Hospital, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 981-8574, Japan. .,Department of Gastrointestinal and Community Medicine, Tohoku University, 16 Kuzehara Uchigo-mimaya cho, Iwaki, Fukushima, 973-8555, Japan.
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Hospital, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 981-8574, Japan
| | - Seiichi Takahashi
- Department of Gastrointestinal and Community Medicine, Tohoku University, 16 Kuzehara Uchigo-mimaya cho, Iwaki, Fukushima, 973-8555, Japan
| | - Daisuke Komazawa
- Department of Gastrointestinal and Community Medicine, Tohoku University, 16 Kuzehara Uchigo-mimaya cho, Iwaki, Fukushima, 973-8555, Japan
| | - Tooru Shimosegawa
- Division of Gastroenterology, Tohoku University Hospital, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 981-8574, Japan
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Yamamoto M, Nishimori H, Iguchi M, Orihashi K. Pathological investigation of graft-related oesophageal fistula. Interact Cardiovasc Thorac Surg 2017; 24:813-814. [PMID: 28453805 DOI: 10.1093/icvts/ivx003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/20/2016] [Indexed: 11/14/2022] Open
Abstract
Oesophageal fistulae after thoracic endovascular aneurysm repair (TEVAR) for thoracic aortic aneurysm (TAA) have been reported, although the causes are unknown. One hypothesis is that the structural configuration of the aortic aneurysm, as it protrudes towards the oesophagus, may affect oesophageal fistula formation. The pathological findings of an oesophageal fistula following TEVAR are reviewed here. This report presents the case of a 68-year-old man with a stent graft-related oesophageal fistula after TEVAR for TAA. The oesophageal fistula suddenly appeared on the 11th day after TEVAR, and oesophagectomy was performed, without stent graft extirpation. The pathological findings showed neutrophil infiltration from the adventitia to the mucosa and congestion in the capillaries of the oesophageal wall around the site of penetration and no bacterial infection. There have been reports with logical hypotheses about the causes of stent graft-related oesophageal fistulae. Our pathological findings support the theory that pressure necrosis or ischaemic insult by physical compression of a rigid thrombosed aneurysm may result in fistula formation. For descending aortic aneurysms that protrude toward the oesophagus, caution must be exercised to prevent oesophageal fistula formation after TEVAR.
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Affiliation(s)
- Masaki Yamamoto
- Department of Surgery 2, Cardiovascular Surgery, Kochi Medical School, Kochi, Japan
| | - Hideaki Nishimori
- Department of Surgery 2, Cardiovascular Surgery, Kochi Medical School, Kochi, Japan
| | - Mitsuko Iguchi
- Department of Pathology, Kochi Medical School, Kochi, Japan
| | - Kazumasa Orihashi
- Department of Surgery 2, Cardiovascular Surgery, Kochi Medical School, Kochi, Japan
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Cheng L, Zhu J, Liu X, Liu W, Hu H, Zhang J, Liang J, Sun L. A Successful Three-Stage Surgical Treatment for Aortoesophageal Fistula After Thoracic Endovascular Aortic Repair and Esophageal Stent Repair. Ann Thorac Surg 2017; 102:e503-e505. [PMID: 27847066 DOI: 10.1016/j.athoracsur.2016.03.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/08/2016] [Accepted: 03/17/2016] [Indexed: 10/20/2022]
Abstract
A 39-year-old man with Stanford B aortic dissection was treated by thoracic endovascular aortic repair (TEVAR) and experienced an aortoesophageal fistula (AEF). After repeated TEVAR and esophageal stent implantation, the hematemesis did not cease although the whole thoracic descending aorta was covered by stents. A three-stage operation was performed, and an AEF 9 cm long was found during the operation. To our knowledge, this may be the largest AEF ever reported. The patient survived without adverse events.
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Affiliation(s)
- Lijian Cheng
- Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Junming Zhu
- Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Engineering Research Center for Vascular Prostheses, Beijing, China.
| | - Xiangyang Liu
- Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Liu
- Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Haiou Hu
- Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Jie Zhang
- Department of Gastroenterology, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiexiong Liang
- Department of General Surgery, Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lizhong Sun
- Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
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Aoki C, Fukuda W, Kondo N, Minakawa M, Taniguchi S, Daitoku K, Fukuda I. Surgical Management of Mycotic Aortic Aneurysms. Ann Vasc Dis 2017; 10:29-35. [PMID: 29034017 PMCID: PMC5579801 DOI: 10.3400/avd.oa.16-00117] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/13/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose: A mycotic aneurysm is an uncommon disease associated with a high mortality rate when managed surgically. This study reviewed our experiences in the surgical management of mycotic aortic aneurysms. Methods: In total, 26 patients who underwent surgery for a mycotic aneurysm were retrospectively reviewed. The mycotic aneurysms involved the thoracic aorta in 9 patients, the thoracoabdominal aorta in 4 patients, and the abdominal aorta in 13 patients. An overt aortic rupture in the mediastinum or retroperitoneal space was detected in 4 patients. Patients were classified into one of two groups, febrile or afebrile, and background characteristics, surgical intervention, and early and late mortalities were all compared. Results: There were 19 patients who underwent open surgery, and 7 patients underwent endovascular repair. No significant differences in the clinical characteristics were found between the two groups; however, the incidence of postoperative complications was significantly higher in the febrile group than in the afebrile group (P=0.024). Overall mortality was 15.4% (4/26), and 30-day mortality was 7.7% (2/26). Conclusion: Although febrile patients had a higher incidence of postoperative complications, surgical mortality from a mycotic aneurysm was within an acceptable range. Each patient should be thoroughly evaluated and treated on a case-by-case basis, using conventional open repair, endovascular repair, or a combination of both approaches.
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Affiliation(s)
- Chikashi Aoki
- Department of Thoracic and Cardiovascular Surgery, Hiro-saki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Wakako Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hiro-saki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Norihiro Kondo
- Department of Thoracic and Cardiovascular Surgery, Hiro-saki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Masahito Minakawa
- Department of Thoracic and Cardiovascular Surgery, Hiro-saki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Satoshi Taniguchi
- Department of Thoracic and Cardiovascular Surgery, Hiro-saki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Kazuyuki Daitoku
- Department of Thoracic and Cardiovascular Surgery, Hiro-saki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Ikuo Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hiro-saki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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41
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Emergency Endovascular Interventions for Ruptured Descending Thoracic Aortic Aneurysm. Ann Vasc Surg 2016; 39:160-166. [PMID: 27671448 DOI: 10.1016/j.avsg.2016.06.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ruptured descending thoracic aortic aneurysm (rDAA) is a rare but devastating condition. Open aortic surgery which uses cardiopulmonary bypass is associated with a high mortality. Thoracic endovascular aortic repair (TEVAR) is a less-invasive approach for which it remains unclear whether outcomes are superior or equivalent to open aortic surgery. In this study, we report our early and midterm outcomes with TEVAR for rDAA. METHODS This is an observational, retrospective, single-center study which included patients with rDAA and treated by TEVAR. The main objective was the 30-day in-hospital mortality. Secondary end points were 30-day in-hospital morbidity, 2-year mortality, and technical problems encountered during procedures. RESULTS Twenty-five patients were included: 14 men and 11 women with a median age of 76 years (69-82 years). Thirty-day in-hospital mortality rate was 36% (95% confidence interval [CI], 20.6-57.9; n = 9), and the 2-year mortality rate was 44% (95% CI, 27.94-66.72; n = 11). Fifteen patients (60%) presented at least 1 major complication, and 8 of those patients had a second surgery because of it. There were 9 technical problems encountered that required additional open procedures to successfully deploy the aortic stent graft: lack of vascular access in 2 cases (8%), short proximal neck in 3 cases (12%), and short distal neck in 4 cases (16%). CONCLUSIONS Mortality and morbidity remain high in patients treated for rDAA by TEVAR. Nonetheless, TEVAR remains an interesting alternative to open aortic surgery especially for older patients with a poor general health and functional status.
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Wormald JCR, Dindyal S, Thomas R, Peters CJ, Sritharan K. Aorto-esophageal fistula: the multi-disciplinary team approach to management. Clin Case Rep 2016; 4:800-2. [PMID: 27525089 PMCID: PMC4974433 DOI: 10.1002/ccr3.631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/27/2016] [Accepted: 06/06/2016] [Indexed: 12/19/2022] Open
Abstract
Aorto‐esophageal fistula is often a terminal event in many patients. The commonest causes are thoracic aortic aneurysm and esophageal malignancy. To achieve a good outcome in this condition, a MDT approach is required that combines the expertize of vascular surgeons, radiologists, and emergency physicians.
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Affiliation(s)
- Justin C R Wormald
- Department of Vascular Surgery St. Mary's Hospital Imperial College Healthcare NHS Trust Praed Street London W2 1NY UK
| | - Shiva Dindyal
- Department of Vascular Surgery St. Mary's Hospital Imperial College Healthcare NHS Trust Praed Street London W2 1NY UK
| | - Robert Thomas
- Department of Radiology St. Mary's Hospital Imperial College Healthcare NHS Trust Praed Street London W2 1NY UK
| | - Christopher John Peters
- Department of General Surgery St. Mary's Hospital Imperial College Healthcare NHS Trust Praed Street London W2 1NY UK
| | - Kaji Sritharan
- Department of Vascular Surgery St. Mary's Hospital Imperial College Healthcare NHS Trust Praed Street London W2 1NY UK
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Lee JH, Na B, Hwang Y, Kim YH, Park IK, Kim KH. Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:54-8. [PMID: 26889449 PMCID: PMC4757400 DOI: 10.5090/kjtcs.2016.49.1.54] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/30/2015] [Accepted: 07/03/2015] [Indexed: 11/19/2022]
Abstract
A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient’s postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up.
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Affiliation(s)
- Jae-Hong Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Bubse Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Yoohwa Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Yong Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Kyung-Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
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Liang H, Chen C, Liu W, Yu F. Definitive Treatment for Aortoesophageal Fistula by Endovascular Stent Graft. Indian J Surg 2015; 78:151-4. [PMID: 27303128 DOI: 10.1007/s12262-015-1383-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022] Open
Abstract
Aortoesophageal fistula (AEF) is a rare and dangerous complication of foreign body ingestion. Endovascular angioplasty has now become a useful option to control fatal hemorrhage, but it still remains controversial to whether endovascular stenting could be used as a definitive procedure or as a temporary measure before definitive surgical treatment. We have successfully treated two AEF cases using thoracic endovascular aortic repair (TEVAR) as definitive treatment to close aortic defect. The separate 2-year and 6-month follow-ups show that patients are in good condition.
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Affiliation(s)
- Hengxing Liang
- Cardio-thoracic Surgery Department in Xiangya, 2nd hospital of Central South University, 39 Central Remin Road, Changsha, Hunan 410011 China
| | - Chen Chen
- Cardio-thoracic Surgery Department in Xiangya, 2nd hospital of Central South University, 39 Central Remin Road, Changsha, Hunan 410011 China
| | - Wenliang Liu
- Cardio-thoracic Surgery Department in Xiangya, 2nd hospital of Central South University, 39 Central Remin Road, Changsha, Hunan 410011 China
| | - Fenglei Yu
- Cardio-thoracic Surgery Department in Xiangya, 2nd hospital of Central South University, 39 Central Remin Road, Changsha, Hunan 410011 China
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Londono R, Badylak SF. Regenerative Medicine Strategies for Esophageal Repair. TISSUE ENGINEERING PART B-REVIEWS 2015; 21:393-410. [PMID: 25813694 DOI: 10.1089/ten.teb.2015.0014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pathologies that involve the structure and/or function of the esophagus can be life-threatening. The esophagus is a complex organ comprising nonredundant tissue that does not have the ability to regenerate. Currently available interventions for esophageal pathology have limited success and are typically associated with significant morbidity. Hence, there is currently an unmet clinical need for effective methods of esophageal repair. The present article presents a review of esophageal disease along with the anatomic and functional consequences of each pathologic process, the shortcomings associated with currently available therapies, and the latest advancements in the field of regenerative medicine with respect to strategies for esophageal repair from benchtop to bedside.
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Affiliation(s)
- Ricardo Londono
- 1 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 School of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Stephen F Badylak
- 1 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,3 Department of Bioengineering, University of Pittsburgh , Pittsburgh, Pennsylvania.,4 Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
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46
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Sentinel bleeding as a sign of gastroaortic fistula formation after oesophageal surgery. Case Rep Surg 2014; 2014:614312. [PMID: 25544927 PMCID: PMC4269212 DOI: 10.1155/2014/614312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/15/2014] [Accepted: 11/15/2014] [Indexed: 01/06/2023] Open
Abstract
Gastroaortic fistula formation is a very rare complication following oesophageal resection and, in most cases, leads to sudden death. We report the case of a 65-year-old male with an adenocarcinoma of the oesophagus who underwent neoadjuvant chemoradiation followed by a minimally invasive transthoracic oesophagectomy with gastric tube reconstruction and intrathoracic anastomosis. After an uneventful postoperative course and hospital discharge, the patient reported blood regurgitation on postoperative day 23. Endoscopy revealed an adherent blood clot on the oesophageal wall, which after dislocation caused exsanguination. Autopsy determined the cause of death being massive haemorrhage due to a gastroaortic fistula. The sudden onset of haemorrhage makes this condition particularly difficult to treat. Recognition of warning signs such as thoracic or epigastric pain, regurgitation of blood, or the passing of bloody stools or melena is crucial in the early detection of fistula and may improve patient outcome.
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47
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Surgery for thoracic aortic disease in Japan: evolving strategies toward the growing enemies. Gen Thorac Cardiovasc Surg 2014; 63:185-96. [DOI: 10.1007/s11748-014-0476-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Indexed: 01/15/2023]
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