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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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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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Li J, Hu Y, Liu W, Tang J, Zhu S, Zeng C. A successful endovascular aortic repair of aortoesophageal fistula following esophagectomy: a case report and literature review. J Cardiothorac Surg 2024; 19:70. [PMID: 38326831 PMCID: PMC10848545 DOI: 10.1186/s13019-024-02540-1] [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: 04/26/2023] [Accepted: 01/28/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is an extremely rare and highly fatal complication leading to a high risk of morbidity and mortality. Successful management of AEF after esophagectomy for esophageal carcinoma has rarely been reported in the literature. CASE PRESENTATION Here we present a rare case of a 44-year-old female with complications of AEF after esophagectomy for esophageal carcinoma, mainly presented as vomiting of blood. Both computed tomographic and computed tomography angiography of the chest showed bilateral pleural effusion and atelectasis, while gastroscopy showed large gastrointestinal bleeding. Emergency surgery was performed that included the removal of the mediastinal abscess, left lower pulmonary wedge resection, and thoracic endovascular aortic repair (TEVAR), followed by supportive treatment. The surgery went successful, and the patient was followed up for 1 year after discharge and showed good recovery. We also reviewed previous literature on the history, causes, pathophysiology, clinical presentation, diagnosis, and treatment of AEF after esophagectomy for esophageal adenocarcinoma. CONCLUSIONS In our case, thoracotomy combined with TEVAR was effective in treating AEF after esophagectomy for esophageal adenocarcinoma. This case provides successful experiences for clinical diagnosis and treatment of AEF after esophagectomy for esophageal carcinoma.
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Affiliation(s)
- Jina Li
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Yan Hu
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Wenliang Liu
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Jingqun Tang
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Song Zhu
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Chao Zeng
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
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Goyal A, Lahiri R, Rakesh NR, Darbari A. Successful Management of Aorto-Oesophageal Fistula Following Accidental Ingestion of Chicken Bone. Cureus 2023; 15:e35959. [PMID: 37041903 PMCID: PMC10082685 DOI: 10.7759/cureus.35959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/11/2023] Open
Abstract
Accidental ingestion of foreign bodies is common in clinical practice. It is usually seen to pass through the gastrointestinal tract easily. However, in the case of impaction in the esophagus, it can lead to catastrophic conditions. Aorto-esophageal fistula is one such disastrous complication with a high fatality rate. Despite treatment, mortality rates of up to 80% have been reported in the literature, with the condition being uniformly fatal in untreated patients. We describe a case of aorto-esophageal fistula secondary to a chicken bone impaction presenting with sentinel hemorrhage and managed expeditiously and successfully with simultaneous endoscopic removal and surgical repair of the fistula.
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Wong AC, Chou YM, Goh ZNL, Chang KF, Seak CJ. Case report: Aortoesophageal fistula-an extremely rare but life-threatening cardiovascular cause of hematemesis. Front Cardiovasc Med 2023; 10:1123305. [PMID: 37153464 PMCID: PMC10157070 DOI: 10.3389/fcvm.2023.1123305] [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] [Received: 12/13/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Aortoesophageal fistula (AEF) is an extremely rare cardiovascular etiology of hematemesis and upper gastrointestinal bleeding. As such, its recognition and diagnosis are challenging and may be delayed when such patients present to the emergency department (ED). Without timely surgical intervention, AEF is almost always fatal. Awareness of AEF as a possible diagnosis and consequently early identification of these patients presenting to the ED are therefore crucial in optimizing clinical outcomes. We report a 45-year-old male presenting to the ED with the classical triad of an AEF (Chiari's triad)-midthoracic pain or dysphagia, a sentinel episode of minor hematemesis, then massive hematemesis with risk of exsanguination. The case report highlights the importance of considering the differential diagnosis of AEF when evaluating patients presenting to the ED with hematemesis, especially if they have predisposing risk factors such as prior aortic or esophageal surgeries, aortic aneurysms, or thoracic malignancies. Patients suspected of having AEF should be prioritized for early computed tomography angiography to expedite diagnosis and treatment.
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Affiliation(s)
- Alexis Ching Wong
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Yu-Mou Chou
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Zhong Ning Leonard Goh
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Kuang-Fu Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Correspondence: Chen-June Seak
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Gadela T, Paravathaneni M, Manney D, Bandla H. A Rare Cause of Gastrointestinal Bleeding: Aorto-Enteric Fistula. Cureus 2022; 14:e27023. [PMID: 35989755 PMCID: PMC9386321 DOI: 10.7759/cureus.27023] [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] [Accepted: 06/29/2022] [Indexed: 11/30/2022] Open
Abstract
Aorto-enteric fistula is defined as an abnormal connection between the gastrointestinal system and the aorta. The patients who develop this condition usually have a grim prognosis and the cases are universally fatal unless intervened with an endovascular repair or open surgical repair. Given the rarity and the relative unfamiliarity of this condition, an understanding of the presentation, pathogenesis, and management is vital to prevent catastrophic complications.
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Zhong XQ, Li GX. Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature. World J Clin Cases 2022; 10:3814-3821. [PMID: 35647167 PMCID: PMC9100730 DOI: 10.12998/wjcc.v10.i12.3814] [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: 06/23/2021] [Revised: 07/30/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare but life-threatening cause of upper gastrointestinal bleeding. Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported. The purpose of this study is to report a case of AEF managed by endovascular aortic repair and review the relevant literature.
CASE SUMMARY A 66-year-old man with upper gastroenterology bleeding presented at the Emergency Department of our hospital complaining of chest pain, fever and hematemesis for 6 h. He had vomited 400 mL of bright-red blood and experienced severe chest pain 6 h prior. He had a past medical history of advanced esophageal cancer. He received chemoradiotherapy but stopped 8 mo prior because of intolerance. A chest contrast computed tomographic scan revealed communication between the esophagus and the descending aorta as well as a descending aortic pseudoaneurysm. According to the symptoms and imaging findings, AEF was our primary consideration. The patient underwent aortic angiography, which indicated AEF and descending aortic pseudoaneurysm. Emergency percutaneous thoracic endovascular aortic repair (TEVAR) of the descending aorta was performed, and bleeding was controlled after TEVAR. He received antibiotics and was discharged after treatment. However, he died 2 mo after the TEVAR due to cancer progression.
CONCLUSION Although AEF is a lethal condition, timely diagnosis and TEVAR may successfully control bleeding.
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Affiliation(s)
- Xue-Qing Zhong
- Department of Gastroenterology and Hepatology, Hangzhou Normal University Affiliated Hospital, Hangzhou 310015, Zhejiang Province, China
- Medical College, Hangzhou Normal University, Hangzhou 311121, Zhejiang Province, China
| | - Guo-Xiong Li
- Department of Gastroenterology and Hepatology, Hangzhou Normal University Affiliated Hospital, Hangzhou 310015, Zhejiang Province, China
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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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Primary aortoesophageal fistula from metallic bristle ingestion. J Vasc Surg Cases Innov Tech 2022; 8:77-80. [PMID: 35128220 PMCID: PMC8799993 DOI: 10.1016/j.jvscit.2021.12.008] [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: 10/22/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Abstract
Although many patients are treated for the removal of ingested foreign objects each year, ingestions that perforate the esophagus and lead to intra-abdominal complications are rare. Aortoesophageal fistulas and aortic pseudoaneurysms are deadly complications of esophageal foreign body impaction. However, the surgical approach to aortic repair from foreign object damage has not been standardized. We have described the diagnostic, open surgical, and therapeutic approach to treating a man who had accidentally ingested a 3-cm metallic bristle that lodged in his aortic wall. The patient recovered after excision of the aortic pseudoaneurysm with CryoGraft (CryoLife, Inc, Kennesaw, Ga) replacement, drainage of abscesses, and antibiotic treatment for multiple infections.
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Couture T, Gaudric J, Davaine JM, Jayet J, Chiche L, Jarraya M, Koskas F. Results of cryopreserved arterial allograft replacement for thoracic and thoracoabdominal aortic infections. J Vasc Surg 2021; 73:626-634. [PMID: 33485491 DOI: 10.1016/j.jvs.2020.05.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Primary and secondary thoracic aortic infections are rare but associated with high morbidity and mortality. There is currently no consensus on their optimal treatment. Arterial allografts have been shown to be resistant to bacterial colonization. Complete excision of infected material, especially synthetic grafts, combined with in situ aortic repair is considered the best treatment of abdominal aortic infections. The aim of this study was to assess the management of thoracic and thoracoabdominal aortic infections using arterial allografts. METHODS Between January 2009 and December 2017, all patients with thoracic and thoracoabdominal aortic native or graft infections underwent complete excision of infected material and in situ arterial allografting. The end points were the early mortality and morbidity rates and early and late rates of reinfection, graft degeneration, and graft-related morbidity. RESULTS Thirty-five patients with a mean age of 65.6 ± 9.2 years were included. Twenty-one (60%) cases experienced graft infections and 14 (40%) experienced native aortic infections. Eight (22.8%) patients had visceral fistulas: 5 (14.4%) prosthetic-esophageal, 1 (2.8%) prosthetic-bronchial, 1 (2.8%) prosthetic-duodenal, and 1 (2.8%) native aortobronchial. In 12 (34.3%) cases, only the descending thoracic aorta was involved; in 23 (65.7%) cases, the thoracoabdominal aorta was involved. Fifteen (42.8%) patients died during the first month or before discharge: 5 of hemorrhage, 4 of multiorgan failure, 3 of ischemic colitis, 2 of pneumonia, and 1 of anastomotic disruption. Eleven (31.5%) patients required early revision surgery: 6 (17.1%) for nongraft-related hemorrhage, 3 (8.6%) for colectomy, 1 (2.9%) for proximal anastomotic disruption, and 1 (2.9%) for tamponade. One (2.9%) patient who died before discharge experienced paraplegia. One (2.9%) patient experienced stroke. Six (17.1%) patients required postoperative dialysis. Among them, four died before discharge. The mean length of stay in the intensive care unit was 11 ± 10.5 days; the mean length of hospital stay was 32 ± 14 days. During a mean follow-up of 32.3 ± 23.7 months, three allograft-related complications occurred in survivors (15% of late survivors): one proximal and one distal false aneurysm with no evidence of reinfection and one allograft-enteric fistula. The 1-year and 2-year survival rates were 49.3% and 42.5%, respectively. CONCLUSIONS Although rare, aortic infections are highly challenging. Surgical management includes complete excision of infected tissues or grafts. Allografts offer a promising solution to aortic graft infection because they appear to resist reinfection; however, the grafts must be observed indefinitely because of the risk of late graft complications.
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Affiliation(s)
- Thibault Couture
- Faculty of Medicine, Sorbonne University, Paris, France; Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France.
| | - Julien Gaudric
- Faculty of Medicine, Sorbonne University, Paris, France; Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
| | - Jean-Michel Davaine
- Faculty of Medicine, Sorbonne University, Paris, France; Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
| | - Jérémie Jayet
- Faculty of Medicine, Sorbonne University, Paris, France; Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
| | - Laurent Chiche
- Faculty of Medicine, Sorbonne University, Paris, France; Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
| | | | - Fabien Koskas
- Faculty of Medicine, Sorbonne University, Paris, France; Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
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Gulati A, Kapoor H, Donuru A, Gala K, Parekh M. Aortic Fistulas: Pathophysiologic Features, Imaging Findings, and Diagnostic Pitfalls. Radiographics 2021; 41:1335-1351. [PMID: 34328814 DOI: 10.1148/rg.2021210004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fistulas between the aorta and surrounding organs are extremely rare but can be fatal if they are not identified and treated promptly. Most of these fistulas are associated with a history of trauma or vascular intervention. However, spontaneous aortic fistulas (AoFs) can develop in patients with weakened vasculature, which can be due to advanced atherosclerotic disease, collagen-vascular disease, vasculitides, and/or hematogenous infections. The clinical features of AoFs are often nonspecific, with patients presenting with bleeding manifestations, back or abdominal pain, fever, and shock. Confirmation with invasive endoscopy is often impractical in the acute setting. Imaging plays an important role in the management of AoFs, and multiphasic multidetector CT angiography is the initial imaging examination of choice. Obvious signs of AoF include intravenous contrast material extravasation into the fistulizing hollow organ, tract visualization, and aortic graft migration into the adjacent structure. However, nonspecific indirect signs such as loss of fat planes and ectopic foci of gas are seen more commonly. These indirect signs can be confused with other entities such as infection and postoperative changes. Management may involve complex and staged surgical procedures, depending on the patient's clinical status, site of the fistula, presence of infection, and anticipated tissue friability. As endovascular interventions become more common, radiologists will need to have a high index of suspicion for this entity in patients who have a history of aneurysms, vascular repair, or trauma and present with bleeding. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. ©RSNA, 2021.
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Affiliation(s)
- Aishwarya Gulati
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., A.D., M.P.); Department of Radiology, University of Kentucky Medical Center, Lexington, Ky (H.K.); and Division of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha University, Mumbai, India (K.G.)
| | - Harit Kapoor
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., A.D., M.P.); Department of Radiology, University of Kentucky Medical Center, Lexington, Ky (H.K.); and Division of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha University, Mumbai, India (K.G.)
| | - Achala Donuru
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., A.D., M.P.); Department of Radiology, University of Kentucky Medical Center, Lexington, Ky (H.K.); and Division of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha University, Mumbai, India (K.G.)
| | - Kunal Gala
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., A.D., M.P.); Department of Radiology, University of Kentucky Medical Center, Lexington, Ky (H.K.); and Division of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha University, Mumbai, India (K.G.)
| | - Maansi Parekh
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., A.D., M.P.); Department of Radiology, University of Kentucky Medical Center, Lexington, Ky (H.K.); and Division of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha University, Mumbai, India (K.G.)
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12
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Chen C, Kim JW, Shin JH, Kwon Y, Kim J, Lee IJ. Management of life-threatening aortoesophageal fistula: experiences learned from eight patients. Acta Radiol 2021; 62:447-452. [PMID: 32551870 DOI: 10.1177/0284185120933228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare but fatal condition causing massive upper gastrointestinal bleeding. PURPOSE To report our experiences in the management of life-threatening AEF. MATERIAL AND METHODS A total of eight patients (seven men, one woman; mean age = 59.4 years; age range = 43‒76 years) presenting with AEF between 2005 and 2018 were recruited from three different Korean hospitals. The medical records of these patients were reviewed for patient demographics, clinical features, diagnostic and therapeutic modalities, and outcomes. RESULTS Two patients died as a result of massive hemorrhage before endovascular or surgical treatment could be undertaken. Of the six patients who were treated, five underwent endovascular interventions: embolization of the fistula using n-butyl cyanoacrylate (NBCA) and subsequent thoracic endovascular aortic repair (TEVAR) in two patients; TEVAR alone in two patients; and NBCA embolization alone in one patient. Among them, three patients who received TEVAR with or without NBCA embolization in a timely fashion recovered and were discharged. One patient who received delayed TEVAR died of disseminated intravascular coagulation, and one who received NBCA embolization alone died of hemorrhagic shock, both dying within three days of treatment. The remaining patient who underwent surgical aortic repair is alive after 13 years. CONCLUSION Rapid identification and surgical treatment are necessary to increase the likelihood of survival, if emergency surgery is feasible. TEVAR in a timely fashion facilitates hemodynamic stabilization by rapidly controlling hemorrhage and saves the patient's life.
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Affiliation(s)
- Chengshi Chen
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yohan Kwon
- Department of Radiology, Ajou University Hospital, Suwon, Republic of Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University Hospital, Suwon, Republic of Korea
| | - In Joon Lee
- Department of Radiology, National Cancer Center, Goyang, Republic of Korea
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Benedetti B, Felice M, Locco F, Roberti P, Demontis R. Lethal aorto-oesophageal fistula 16 years after aortic prosthetic reconstruction: Delayed rupture as cause of death. MEDICINE, SCIENCE, AND THE LAW 2021; 61:146-149. [PMID: 32689878 DOI: 10.1177/0025802420936796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The development of aorto-oesophageal fistula (AOF) is a rare complication following thoracic aortic repair. Mortality is high, in most cases due to fatal haematemesis. The clinical onset is variable, occurring approximately one year after surgery. We report a case of a lethal AOF in a 58-year-old man. He underwent open vascular surgery 16 years prior to his death due to a rupture of the descending thoracic aorta. In the early 2000s, the open vascular approach was replaced by thoracic endovascular aortic repair. As a result of this approach, the number of surgical complications has reduced, with the exception of AOF.
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Affiliation(s)
- Beatrice Benedetti
- Legal Medicine Unit, Department of Medical Sciences and Public Health,3111University of Cagliari, Italy
| | - Marica Felice
- Legal Medicine Unit, Department of Medical Sciences and Public Health,3111University of Cagliari, Italy
| | - Francesco Locco
- Legal Medicine Unit, Department of Medical Sciences and Public Health,3111University of Cagliari, Italy
| | - Paola Roberti
- Legal Medicine Unit, Department of Medical Sciences and Public Health,3111University of Cagliari, Italy
| | - Roberto Demontis
- Legal Medicine Unit, Department of Medical Sciences and Public Health,3111University of Cagliari, Italy
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Vijayvergiya R, Kasinadhuni G, Sinha SK, Yadav TD, Singh H, Savlania A, Lal A, Kanabar K. Thoracic endovascular aortic repair in management of aorto-oesophageal fistulas: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 33204973 PMCID: PMC7649481 DOI: 10.1093/ehjcr/ytaa295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/29/2020] [Accepted: 08/04/2020] [Indexed: 12/02/2022]
Abstract
Background Aorto-oesophageal fistula (AOF) is a rare, catastrophic disease with an extremely poor prognosis. A ruptured thoracic aortic aneurysm is a common aetiology for AOF. The clinical presentation is usually massive haematemesis and collapse. Timely diagnosis and appropriate treatment are crucial in managing AOF. Case summary We hereby report two cases of AOF, who underwent successful emergency thoracic endovascular aortic repair (TEVAR) to control active bleed and exsanguination. Case 1, an elderly lady with atherosclerotic aneurysm had TEVAR followed by open surgery for oesophageal rent and necrosed left main bronchus. Case 2 had mycotic tubercular aneurysm who later had infected graft-stent following TEVAR. Discussion Open surgery is the conventional treatment for AOF; however, TEVAR can be an alternative and less invasive approach in selected high-risk patients. Various management issues related to TEVAR with AOF have been discussed in the article.
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Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Saroj Kant Sinha
- Department of Gastroenterology, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Thakur Deen Yadav
- Department of Gastro-intestinal Surgery, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Harkant Singh
- Department of Cardio-thoracic Surgery, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Ajay Savlania
- Department of Vascular Surgery, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Anupam Lal
- Department of Radio-diagnosis, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Kewal Kanabar
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
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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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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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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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Zeng L, Shu W, Ma H, Hu J. Aortic injury caused by esophageal foreign body-case reports of 3 patients and literature review. Medicine (Baltimore) 2020; 99:e20849. [PMID: 32590781 PMCID: PMC7328905 DOI: 10.1097/md.0000000000020849] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Ingestion of a foreign body can cause different degrees of damage to esophagus, and several complications are potentially life-threatening if not properly handled. The aortic injury caused by a perforating esophageal foreign body is rare but lethal. The optimal management still remains controversial. The purpose of this report is to describe our experience in the management of the aortic injury caused by esophageal foreign body ingestion. METHODS Between January 2015 and December 2015, we retrospectively enrolled cases of esophageal perforation involving the aorta by foreign body. The general parameters, esophageal foreign body, types of aortic injury, treatment, and outcome were analyzed. Additionally, we reviewed the literature of the management of esophageal perforation involving the aorta caused by foreign bodies. The study was approved by the ethics committee of the First Affiliated Hospital, College of Medicine, Zhejiang University, and the need for informed consent was waived (Quick review 2019, No. 609). RESULTS Three cases of esophageal perforation involving the aorta by foreign body was selected in the study. Two male and 1 female patients (range, 51-58 years old) with the aorta involvement caused by a perforating foreign body in the esophagus in 3 forms were identified, including 1 patient with mycotic aortic pseudoaneurysm, 1 patient with aortoesophageal fistula and 1 patient with the aortic intramural hematoma. One patient died of the rupture of the pseudoaneurysm during the preparation of the surgery. The other 2 patients were cured with a multidisciplinary approach, which is an urgent thoracic endovascular aortic repair followed by mediastinal debridement/drainage or endoscopic retrieval. Two of 3 patients were survived until now. CONCLUSION The management of the aortic injury caused by esophageal foreign body injury is challenging. Early diagnosis and multidisciplinary management is crucial.
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19
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Saha BK. Few and Far Between: A Case of Aortoesophageal Fistula in Locally Advanced Esophageal Cancer. Am J Med Sci 2020; 361:e3-e4. [PMID: 32631579 DOI: 10.1016/j.amjms.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/05/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Biplab K Saha
- Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, Missouri.
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20
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Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, Fourneau I, Glaudemans AWJM, Koncar I, Lindholt J, Melissano G, Saleem BR, Senneville E, Slart RHJA, Szeberin Z, Venermo M, Vermassen F, Wyss TR, de Borst GJ, Bastos Gonçalves F, Kakkos SK, Kolh P, Tulamo R, Vega de Ceniga M, von Allmen RS, van den Berg JC, Debus ES, Koelemay MJW, Linares-Palomino JP, Moneta GL, Ricco JB, Wanhainen A. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg 2020; 59:339-384. [PMID: 32035742 DOI: 10.1016/j.ejvs.2019.10.016] [Citation(s) in RCA: 272] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Kahlberg A, Grandi A, Loschi D, Vermassen F, Moreels N, Chakfé N, Melissano G, Chiesa R. A systematic review of infected descending thoracic aortic grafts and endografts. J Vasc Surg 2019; 69:1941-1951.e1. [PMID: 30606664 DOI: 10.1016/j.jvs.2018.10.108] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of this study was to collect and critically analyze the current evidence on the modalities and results of treatment of descending thoracic aortic surgical graft (SG) and endograft (EG) infection, which represents a rare but dramatic complication after both surgical and endovascular aortic repair. METHODS A comprehensive electronic health database search (PubMed/MEDLINE, Scopus, Google Scholar, and the Cochrane Library) identified all articles that were published up to October 2017 reporting on thoracic aortic SG or EG infection. Observational studies, multicenter reports, single-center series and case reports, case-control studies, and guidelines were considered eligible if reporting specific results of treatment of descending thoracic aortic SG or EG infection. Comparisons of patients presenting with SG or EG infection and between invasive and conservative treatment were performed. Odds ratio (OR) meta-analyses were run when comparative data were available. RESULTS Forty-three studies reporting on 233 patients with infected SG (49) or EG (184) were included. Four were multicenter studies including 107 patients, all with EG infection, associated with a fistula in 91% of cases, with a reported overall survival at 2 years of 16% to 39%. The remaining 39 single-center studies included 49 patients with SG infection and 77 with EG infection. Association with aortoesophageal fistula was significantly more common with EG (60% vs 31%; P = .01). In addition, time interval from index procedure to infection was significantly shorter with EG (17 ± 21 months vs 32 ± 61 months; P = .03). Meta-analysis showed a trend of increased 1-year mortality in patients with SG infection compared with EG infection (pooled OR, 3.6; 95% confidence interval, 0.9-14.7; P = .073). Surgical management with infected graft explantation was associated with a trend toward lower 1-year mortality compared with graft preservation (pooled OR, 0.3; 95% confidence interval, 0.1-1.0; P = .056). CONCLUSIONS Thoracic aortic EG infection is likely to occur more frequently in association with aortoesophageal fistulas and in a shorter time compared with SG infection. Survival is poor in both groups, especially in patients with SG infection. Surgical treatment with graft explantation seems to be the preferable choice in fit patients.
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Affiliation(s)
- Andrea Kahlberg
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy.
| | - Alessandro Grandi
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Diletta Loschi
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Frank Vermassen
- Department of Vascular and Thoracic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Nathalie Moreels
- Department of Vascular and Thoracic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Germano Melissano
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy
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Successful surgical repair of aorto-esophageal fistula due to fish-bone ingestion. Indian J Thorac Cardiovasc Surg 2019; 35:68-70. [PMID: 33060974 DOI: 10.1007/s12055-018-0704-5] [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: 05/07/2018] [Revised: 06/19/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022] Open
Abstract
Aorto-esophageal fistula is a rare and potentially lethal disease. The main causes are ruptured aortic aneurysm, foreign body ingestion, complication of surgical or endovascular repair of thoracic aortic aneurysm, and esophageal malignancy. We report a case caused by fish-bone ingestion. He underwent replacement of proximal descending aorta using circulatory arrest and trans-hiatal esophagectomy in the same sitting. A second-stage esophago-coloplasty was performed after 6 months for establishing digestive tract continuity.
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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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Wong PC, Chan YC, Law Y, Keung Cheng SW. Emergency aortic stent-graft treatment for malignant aortoesophageal fistula. Asian Cardiovasc Thorac Ann 2017; 25:649-652. [DOI: 10.1177/0218492317741788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Two patients with locally advanced squamous cell carcinoma of the mid-esophagus, with esophageal stents in situ, suffered sudden onset of massive hematemesis and hemodynamic instability due to an aortoesophageal fistula. Although their esophageal neoplasms were deemed inoperable and treatment was palliative, the bleeding was successfully stopped with an endovascular aortic stent-graft. They both remained stable with no septic or hemorrhagic complications, and survived for 14 and 16 weeks after the operation. We emphasize that even if esophageal tumors are locally advanced, emergency endovascular management of aortoesophageal fistula is worthwhile for prolongation of survival.
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Affiliation(s)
- Pak Chiu Wong
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Yiu Che Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Yuk Law
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Stephen Wing Keung Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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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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Yaguchi Y, Kumata Y, Horikawa M, Kiyokawa T, Inaba T, Fukushima R. Seven esophageal perforation cases after aortic replacement/stenting for thoracic aortic dissection or aneurysm. Surg Case Rep 2017. [PMID: 28631201 PMCID: PMC5476534 DOI: 10.1186/s40792-017-0354-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Esophageal perforation after aortic replacement/stenting for aortic dissection or aneurysm is a rare but severe complication. However, its cause, standard treatment, and prognosis are unclear. We analyzed the treatment and outcome retrospectively from seven cases experienced at our hospital. Case presentation The median age of the patients was 70 years (range, 41–86), and six of the seven cases were male. As the first treatment, aortic replacement techniques were performed in five, and thoracic endovascular aortic repair (TEVAR) procedure was performed in two. We evaluated the treatment of the perforation, the cause of death, and the median survival time after reparative surgery (esophagectomy). Initial treatment of the perforation was esophagectomy without reconstruction in six and esophagogastric bypass (later, esophagectomy was performed) in one. Three of seven cases could be discharged from hospital or moved to another hospital, but two of these three cases died of major bleeding on postoperative days 320 and 645. The other four esophagectomy cases died in hospital because of sepsis on postoperative days 14, 30, and 41 and major bleeding on postoperative day 54. The one surviving case was a 65-year-old man who underwent reconstruction, and was still alive without signs of infection at 424 days postoperatively. Conclusion The prognosis of esophageal perforation cases after aortic replacement/stenting for thoracic aortic dissection or aneurysm is poor, though there were some cases with relatively long survival. Therefore, the indication for invasive esophagectomy should be decided carefully. Control of infection including regional infection is essential for successful treatment.
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Affiliation(s)
- Yoshihisa Yaguchi
- Department of Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Yoshimasa Kumata
- Department of Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Masahiro Horikawa
- Department of Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Takashi Kiyokawa
- Department of Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Tsuyoshi Inaba
- Department of Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Ryoji Fukushima
- Department of Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
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Sladojevic M, Bjelovic M, Ilic N, Mutavdzic P, Koncar I, Dragas M, Markovic M, Davidovic L. Open Surgical Treatment of Secondary Aortoesophageal and Aortobronchial Fistula after Thoracic Endovascular Aortic Repair and Esophagocoloplasty in a Second Procedure. Ann Vasc Surg 2017; 44:417.e11-417.e16. [PMID: 28502887 DOI: 10.1016/j.avsg.2017.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/21/2017] [Indexed: 11/20/2022]
Abstract
Aortoesophageal (AEF) and aortobronchial fistula (ABF) after thoracic endovascular aortic repair (TEVAR) are rare complications with catastrophic consequences without treatment. In this case report, we presented a patient with AEF and ABF after TEVAR successfully treated with endograft explantation and replaced by Dacron graft followed by esophagectomy and left principal bronchus repairing. We report a patient with AEF and ABF after TEVAR who was evaluated due to dysphagia and chest pain followed by hematemesis and hemoptysis. Endoscopic examination revealed lesion of the esophageal wall with chronic abscess formation and stent-graft protrusion into the cavity. Patient was operated on with extracorporeal circulation. AEF and ABF were confirmed intraoperatively. Endograft was explanted and in situ reconstruction of thoracic aorta was carried out with tubular Dacron 22-mm prosthesis wrapped with omental flap. After aortic reconstruction, esophageal mucosal stripping was performed with cervical esophagostomy, pyloromyotomy, and Stamm-Kader gastrostomy for nutrition. In addition, omentoplasty of the defect in the left principal bronchus was performed. To re-establish peroral food intake esophagocoloplasty was carried out 8 months after previous surgery utilizing transversosplenic segment of the colon and retrosternal route. In very selective cases, stent-graft explantation and in situ reconstruction with Dacron graft covered by omental flap followed by esophagectomy and bronchus repairing permit adequate debridement reducing the risk of mediastinitis and graft infection and allow a safe esophageal reconstruction in a second procedure.
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Affiliation(s)
- Milos Sladojevic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
| | - Milos Bjelovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery - First Surgical Hospital, Clinical Center of Serbia, Belgrade, Serbia
| | - Nikola Ilic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Perica Mutavdzic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Igor Koncar
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko Dragas
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miroslav Markovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Lazar Davidovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Afifi RO, Mushtaq HH, Sandhu HK, Khalil K, Safi HJ, Estrera AL. Successful Multistaged Surgical Management of Secondary Aortoesophageal Fistula With Graft Infection. Ann Thorac Surg 2017; 101:e203-5. [PMID: 27211982 DOI: 10.1016/j.athoracsur.2015.10.099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/16/2015] [Accepted: 10/26/2015] [Indexed: 10/21/2022]
Abstract
Secondary aortoenteric fistula is a rare and dreaded complication of aortic graft replacement. This case demonstrates successful management of a patient with thoracic aortic graft infection resulting in aortoesophageal fistula and the feasibility of combined endovascular approach as a temporary measure to stabilize the patient in extremis, followed by a definitive surgical repair. The patient had a remote history of descending aortic repair and an emergent thoracic endovascular aortic repair for upper gastrointestinal bleeding 2 months ago. We performed a three-staged operation involving extraanatomic bypass, total infected aortic graft excision, and primary closure of the esophageal perforation with muscle flap coverage, from which he eventually recovered.
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Affiliation(s)
- Rana O Afifi
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Texas
| | - Harith H Mushtaq
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Texas
| | - Harleen K Sandhu
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Texas
| | - Kamal Khalil
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Texas; Memorial Hermann Heart & Vascular Institute-Texas Medical Center, Houston, Texas
| | - Hazim J Safi
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Texas; Memorial Hermann Heart & Vascular Institute-Texas Medical Center, Houston, Texas
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Texas; Memorial Hermann Heart & Vascular Institute-Texas Medical Center, Houston, Texas.
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29
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Ren W, He Y, Wang X, Peng Z. Secondary aorto-esophageal fistula after esophagectomy treated with endovascular treatment: A case report. Medicine (Baltimore) 2017; 96:e6555. [PMID: 28383428 PMCID: PMC5411212 DOI: 10.1097/md.0000000000006555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Aorto-esophageal fistula (AEF), a postoperative complication of esophagectomy, constitutes a very small percentage of all cases presenting with AEF; however, it is associated with a high mortality rate. Acute massive hemorrhage is the single largest cause of death in patients developing AEF. There is a lack of consensus on the optimal treatment of AEF. PATIENT CONCERNS We present 3 cases secondary to esophagectomy due to lower thoracic esophageal carcinoma. All 3 patients presented with similar acute symptoms including a critical and life-threatening course with dead feeling, thoracic pain, and projectile hematemesis, and also hypovolemic shock. DIAGNOSES Digital subtraction angiography identified AEF as the diagnosis of these 3 cases. INTERVENTIONS All patients were treated with emergency thoracic endovascular aortic repair, the aortic fistulas were repaired. OUTCOMES All patients successfully survived the perioperative period. LESSONS Thoracic endovascular aortic repair, a minimally invasive technique, is a better method to achieve faster and safer hemodynamic stability in patients with AEF compared with open thoracic aortic repair.
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Affiliation(s)
| | - Yuxiang He
- Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, P.R. China
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30
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Marini T, Desai A, Kaproth-Joslin K, Wandtke J, Hobbs SK. Imaging of the oesophagus: beyond cancer. Insights Imaging 2017; 8:365-376. [PMID: 28303554 PMCID: PMC5438315 DOI: 10.1007/s13244-017-0548-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/08/2017] [Accepted: 02/13/2017] [Indexed: 12/27/2022] Open
Abstract
Abstract Non-malignant oesophageal diseases are critical to recognize, but can be easily overlooked or misdiagnosed radiologically. In this paper, we cover the salient clinical features and imaging findings of non-malignant pathology of the oesophagus. We organize the many non-malignant diseases of the oesophagus into two major categories: luminal disorders and wall disorders. Luminal disorders include dilatation/narrowing (e.g. achalasia, scleroderma, and stricture) and foreign body impaction. Wall disorders include wall thickening (e.g. oesophagitis, benign neoplasms, oesophageal varices, and intramural hematoma), wall thinning/outpouching (e.g. epiphrenic diverticulum, Zenker diverticulum, and Killian-Jamieson diverticulum), wall rupture (e.g. iatrogenic perforation, Boerhaave Syndrome, and Mallory-Weiss Syndrome), and fistula formation (e.g. pericardioesophageal fistula, tracheoesophageal fistula, and aortoesophageal fistula). It is the role of the radiologist to recognize the classic imaging patterns of these non-malignant oesophageal diseases to facilitate the delivery of appropriate and prompt medical treatment. Teaching Points • Nonmalignant oesophageal disease can be categorised by the imaging appearance of wall and lumen. • Scleroderma and achalasia both cause lumen dilatation via different pathophysiologic pathways. • Oesophageal wall thickening can be inflammatory, neoplastic, traumatic, or vascular in aetiology.
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Affiliation(s)
- Thomas Marini
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA.
| | - Amit Desai
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - Katherine Kaproth-Joslin
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - John Wandtke
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
| | - Susan K Hobbs
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA
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31
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Gombert A, Grommes J, Schick G, Binnebösel M, Klink C, Jacobs MJ, Kotelis D. Sarcoidosis-Associated Aortoesophageal Fistula—Multistage Interdisciplinary Surgical Therapy for a Rare and Life-Threatening Condition. Ann Vasc Surg 2017; 39:287.e15-287.e20. [DOI: 10.1016/j.avsg.2016.06.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/09/2016] [Accepted: 06/27/2016] [Indexed: 02/09/2023]
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Atypical Aortoesophageal Fistula with Atypical and Delayed Presentation and Negative Imaging Studies. Case Rep Gastrointest Med 2016; 2016:7219034. [PMID: 27965903 PMCID: PMC5124669 DOI: 10.1155/2016/7219034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/30/2016] [Indexed: 12/30/2022] Open
Abstract
A 59-year-old man with past medical history of thoracic aortic aneurysm treated with thoracic endovascular aortic repair presented with melena for 2 weeks. Initial EGD did not reveal the source of bleeding and showed normal esophagus; abdominal arteriogram did not reveal a fistulous communication and initial CTA showed normal position of the aortic graft stent without endoleak. The sixth EGD revealed a submucosal tumor-like projection in the upper esophagus and stigmata of recent bleeding. Another thoracic endovascular aortic repair with stent was placed over the old graft for presumed aortoesophageal fistula. Poststent upper gastrointestinal series with contrast showed extravasation of the contrast from the esophagus and CTA showed fistulous tract between aorta and esophagus. The patient refused definitive surgical repair despite having infected aortic graft; jejunostomy tube was placed and life-long suppressive antibiotic treatment was given and the patient is doing well at 2-year follow-up.
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33
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Emergency Double-Stenting and Surgery for the Successful Management of Massive Upper Gastrointestinal Bleeding Caused by Mycotic Aortic Aneurysm. Clin Gastroenterol Hepatol 2015; 13:e171-2. [PMID: 25912836 DOI: 10.1016/j.cgh.2015.04.016] [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: 03/03/2015] [Revised: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 02/07/2023]
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34
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Combined Treatment of an Aortoesophageal Fistula After Aortoplasty for Aortic Stenosis. Ann Thorac Surg 2015; 100:1091-3. [PMID: 26354638 DOI: 10.1016/j.athoracsur.2014.11.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/01/2014] [Accepted: 11/12/2014] [Indexed: 10/23/2022]
Abstract
The aortoesophageal fistula secondary to the rupture of an aneurysm is a rare entity that usually has a fatal outcome. We present the case of a young patient with an aortoesophageal fistula secondary to a thoracic aortic aneurysm successfully treated with a combination of endoscopic and surgical techniques.
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35
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Kahlberg A, Tshomba Y, Marone EM, Castellano R, Melissano G, Chiesa R. Current Results of a Combined Endovascular and Open Approach for the Treatment of Aortoesophageal and Aortobronchial Fistulae. Ann Vasc Surg 2014; 28:1782-8. [DOI: 10.1016/j.avsg.2014.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/03/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022]
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36
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Dumfarth J, Dejaco H, Krapf C, Schachner T, Wykypiel H, Schmid T, Pratschke J, Grimm M. Aorto-Esophageal Fistula After Thoracic Endovascular Aortic Repair: Successful Open Treatment. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:37-40. [PMID: 26798713 DOI: 10.12945/j.aorta.2014.13-056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 12/19/2013] [Indexed: 11/18/2022]
Abstract
We present the case of a 56-year-old patient suffering from an aorto-esophageal fistula after complex treatment of acute Type A dissection including thoracic endovascular aortic repair (TEVAR) of the descending aorta. Open surgical descending replacement using a pericardial patch, as well as esophagectomy, was performed. After a long and complicated hospital stay, the patient finally recovered and was discharged in stable condition. By choosing an aggressive surgical approach the patient survived this devastating complication of TEVAR, which is associated with high mortality.
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Affiliation(s)
- Julia Dumfarth
- Department of Cardiac Surgery, University Clinic Innsbruck, Innsbruck, Austria
| | - Hannes Dejaco
- Department of Anesthesiology, University Clinic Innsbruck, Innsbruck, Austria; and
| | - Christoph Krapf
- Department of Cardiac Surgery, University Clinic Innsbruck, Innsbruck, Austria
| | - Thomas Schachner
- Department of Cardiac Surgery, University Clinic Innsbruck, Innsbruck, Austria
| | - Heinz Wykypiel
- Department of Visceral, Transplant and Thoracic Surgery, University Clinic Innsbruck, Innsbruck, Austria
| | - Thomas Schmid
- Department of Visceral, Transplant and Thoracic Surgery, University Clinic Innsbruck, Innsbruck, Austria
| | - Johann Pratschke
- Department of Visceral, Transplant and Thoracic Surgery, University Clinic Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, University Clinic Innsbruck, Innsbruck, Austria
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37
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Canaud L, Alric P, Gandet T, Ozdemir B, Albat B, Marty-Ane C. Open Surgical Secondary Procedures after Thoracic Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2013; 46:667-74. [DOI: 10.1016/j.ejvs.2013.08.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 08/18/2013] [Indexed: 12/01/2022]
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38
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Canaud L, Ozdemir BA, Bee WW, Bahia S, Holt P, Thompson M. Thoracic endovascular aortic repair in management of aortoesophageal fistulas. J Vasc Surg 2013; 59:248-54. [PMID: 24199764 DOI: 10.1016/j.jvs.2013.07.117] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/29/2013] [Accepted: 07/29/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To provide a systematic review of the outcomes of thoracic endovascular aortic repair (TEVAR) for aortoesophageal fistula (AEF) and to identify prognostic factors associated with poor outcomes. METHODS Literature searches of the Embase, Medline, and Cochrane databases identified relevant articles reporting results of TEVAR for AEF. The main outcome measure was the composite of aortic mortality, recurrence of the AEF, and stent graft explantation. The secondary outcome measure was aortic-related mortality. RESULTS Fifty-five articles were integrated after a literature search identified 72 patients treated by TEVAR for AEFs. The technical success rate of TEVAR was 87.3%. The overall 30-day mortality was 19.4%. Prolonged antibiotics (>4 weeks) were administered in 80% of patients. Concomitant or staged resection or repair of the esophagus was performed in 44.4% of patients. Stent graft explantation was performed within the first month after TEVAR as a planned treatment in 11.1%. After a mean follow-up of 7.4 months (range, 1-33 months), the all-cause mortality was 40.2%, and the aortic-related mortality was 33.3. Prolonged antibiotic treatment (P = .001) and repair of AEFs due to a foreign body (P = .038) were associated with a significant lower aortic mortality. On univariate analysis, TEVAR and concomitant or staged adjunctive procedures (resection, repair of the esophagus, or a planned stent graft explantation) were associated with a significantly lower incidence of aortic-related mortality (P = .0121). When entered into a binary logistic regression analysis, prolonged antibiotic treatment was the only factor associated with a significant lower incidence of the endpoint (P = .003). CONCLUSIONS Late infection or recurrence of the AEF and associated mortality rates are high when TEVAR is used as a sole therapeutic strategy. Prolonged antibiotic treatment has a strong negative association with mortality. A strategy of a temporizing endovascular procedure to stabilize the patient in extremis, and upon recovery, an open surgical esophageal repair with or without stent graft explantation is advocated.
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Affiliation(s)
- Ludovic Canaud
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.
| | - Baris Ata Ozdemir
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
| | - William Wynter Bee
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
| | - Sandeep Bahia
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
| | - Peter Holt
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
| | - Matt Thompson
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
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Xu R, Wang T, Li D, Zhu Z, Zhang S, Xuan C, Yan W, Liu K. Surgical approach for the treatment of aortoesophageal fistula combined with dual aortic aneurysms: a case report. J Cardiothorac Surg 2013; 8:206. [PMID: 24180498 PMCID: PMC4228427 DOI: 10.1186/1749-8090-8-206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 10/28/2013] [Indexed: 12/26/2022] Open
Abstract
Aortoesophageal fistula is a rare disease with a high mortality rate. The disease is with high mortality due to aneurysm rupture, and thus successfully managed cases are rarely reported. Here, we report a case of aortoesophageal fistula caused by a huge descending aneurysm and another smaller aneurysm found in the aortic arch. Such case was relatively rare in the cardiovascular field. Due to the limited experience, it was difficult to determine the proper therapeutic strategy. For this case, for the dual aneurysm, we surgically inserted an aortic endovascular stent-graft to exclusive the aneurysm and simultaneously repair the other aortic arch aneurysm. The patient had an uneventful recovery and was discharged after 1 month antibiotics therapy for the palliative treatment of the esophageal fistula. She survived for 8 months at home before dying of massive hematemesis. Here, we present the operative method and our therapeutic experience for this extremely rare case.
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Affiliation(s)
- Rihao Xu
- Department of Cardiovascular Surgery, Second Hospital of Jilin University, Jilin University, Changchun, Jilin 130041, China.
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40
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Miyahara S, Nomura Y, Shirasaka T, Taketoshi H, Yamanaka K, Omura A, Sakamoto T, Inoue T, Minami H, Okada K, Okita Y. Early and Midterm Outcomes of Open Surgical Correction After Thoracic Endovascular Aortic Repair. Ann Thorac Surg 2013; 95:1584-90. [DOI: 10.1016/j.athoracsur.2013.02.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 02/12/2013] [Accepted: 02/15/2013] [Indexed: 10/27/2022]
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41
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Murphy K, Al-Jundi W, Nawaz S. Mycotic aneurysms of the abdominal aorta due to Listeria monocytogenes. Int J Surg Case Rep 2013; 4:626-8. [PMID: 23711639 DOI: 10.1016/j.ijscr.2013.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 01/08/2013] [Accepted: 02/18/2013] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Infected abdominal aortic aneurysms (AAAs) can present insidiously with non-specific symptoms or they may present as ruptured AAA in the classical manner. PRESENTATION OF CASE We report two cases of mycotic AAA with Listeria monocytogenes. One patient presented with a ruptured aneurysm, while the other patient had a symptomatic non-ruptured presentation with computer tomography (CT) angiogram demonstrating peri-aortic inflammatory change of a rapidly expanding aneurysm. Both patients were treated with excision of the infected tissue and inlay prosthetic surgical repair as well as long term antibiotics. DISCUSSION Arterial aneurysms caused by L. monocytogenes are rare. Risk factors include immunosuppression, infective endocarditis, intravenous drug use and septicaemia. Listeria infections should be discussed with the Health Protection Agency and local microbiologists due to their ubiquity. CONCLUSION Abdominal aortic aneurysm due to L. monocytogenes is best managed via surgical resection in combination with long term antimicrobial therapy. The role of endovascular exclusion is unclear.
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Affiliation(s)
- Kieran Murphy
- Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, United Kingdom.
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42
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Göbölös L, Miskolczi S, Pousios D, Tsang GM, Livesey SA, Barlow CW, Kaarne M, Shambrook J, Lipnevicius A, Ohri SK. Management options for aorto-oesophageal fistula: case histories and review of the literature. Perfusion 2013; 28:286-90. [PMID: 23401340 DOI: 10.1177/0267659113476329] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE An aorto-oesophageal fistula is a rare clinical entity, leading to life-threatening gastrointestinal bleeding. Thoracic aortic aneurysms are the most common cause of aorto-oesophageal fistulae; further causes involve foreign body ingestion, trauma (in most cases iatrogenic), carcinoma or, very rarely, aortitis tuberculotica. METHODS Due to its rarity, there are no large multicentre studies present to evaluate the efficacy of different therapeutic management options. Since it is associated with significant morbidity and mortality, we give a short summary of various treatment approaches performed in our clinical practice in the past three years. The most straightforward therapeutic option may be an endovascular aortic repair and subtotal oesophageal resection followed by gastro-oesophageal reconstruction, but other alternative treatment possibilities are also present, although with probable higher morbidity. CONCLUSIONS Eliminating the source of bleeding as an emergency, resecting the oesophagus urgently to prevent sepsis and reconstructing the gastrointestinal continuity as an elective case after having the inflammatory processes settled seems to justify the endovascular aortic repair and subtotal oesophageal resection, followed by a gastro-oesophageal reconstruction, as an effective surgical approach.
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Affiliation(s)
- L Göbölös
- Department Cardiothoracic Surgery, Southampton General Hospital, Southampton University Hospital Trust, Southampton, UK.
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43
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Ko SF, Lu HI, Ng SH, Kung CT. Fishbone penetration of the thoracic esophagus with prolonged asymptomatic impaction within the aorta. J Vasc Surg 2013; 57:518-20. [DOI: 10.1016/j.jvs.2012.08.067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 08/17/2012] [Accepted: 08/17/2012] [Indexed: 02/06/2023]
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Hong M, Warum D, Karamanian A. Spontaneous intramural esophageal hematoma (IEH) secondary to anticoagulation and/or thrombolysis therapy in the setting of a pulmonary embolism: a case report. J Radiol Case Rep 2013; 7:1-10. [PMID: 23705034 DOI: 10.3941/jrcr.v7i2.1210] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Intramural esophageal hematoma is part of a spectrum of esophageal injuries. Vomiting and straining, endoscopic procedures and bleeding disorders are the most common predisposing factors. However, it can also be an unusual complication of anticoagulation and/or thrombolysis therapy. The most common symptoms are retrosternal chest pain, dysphagia and hematemesis. Computed tomography is the modality of choice and treatment is medically conservative with the cessation of Warfarin and thrombolysis use. When anticoagulation and/or thrombolysis therapy is necessary, periodic reassessment for symptoms of intramural esophageal hematoma may be helpful for early identification and management. We described one case of intramural esophageal hematoma possibly resulting from anticoagulation and/or thrombolysis therapy in the setting of pulmonary embolism.
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Affiliation(s)
- Melina Hong
- Saba University School of Medicine, Saba, Netherland-Antilles.
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Tay YK, Tay JY, Dandie L, Gribbin J. Intramural hematoma of the esophagus mimicking hemorrhaging esophageal cancer. Ann Gastroenterol 2013; 26:74-76. [PMID: 24714326 PMCID: PMC3959523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 07/02/2012] [Indexed: 11/16/2022] Open
Abstract
Intramural hematoma of the esophagus (IHE) is an uncommon esophageal injury. Diagnosis requires high index of suspicion as it can mimic various other cardiovascular, pulmonary, mediastinal or esophageal diseases. Although multiple imaging modalities have been reported to be useful, CT with intravenous contrast should be the imaging modality of choice if not contraindicated. Treatment of IHE is mainly supportive; complete resolution in several weeks is the expected outcome. It is crucial that this condition is recognized and considered in the differential diagnosis of any patients who present with chest pain or dysphagia.
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Affiliation(s)
- Yeng Kwang Tay
- Department of Upper Gastrointestinal Surgery, Southern Helath (Yeng Kwang Tay, Lachlan Dandie, John Gribbin
| | - Jia Yin Tay
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne(Jia Yin Tay), Victoria, Australia
| | - Lachlan Dandie
- Department of Upper Gastrointestinal Surgery, Southern Helath (Yeng Kwang Tay, Lachlan Dandie, John Gribbin
| | - John Gribbin
- Department of Upper Gastrointestinal Surgery, Southern Helath (Yeng Kwang Tay, Lachlan Dandie, John Gribbin,
Correspondence to: Mr. John Gribbin, Upper Gastrointestinal Surgery Unit, Monash Medical Centre, 246 Clayton Road, Clayton, 3168 Victoria, Australia, Tel.: +61 3 9594 6666, Fax: +61 3 9594 6053, e-mail:
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Ishikawa N, Maruta K, Oi M, Iizuka H, Kawaura H, Omoto T. Thoracic Endovascular Repair for Aorto-Esophageal Fistula in Patients With Esophageal Carcinoma. Vasc Endovascular Surg 2012; 47:65-9. [DOI: 10.1177/1538574412467858] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aorto-esophageal fistula (AEF) is a rare complication of esophageal carcinoma. Left untreated, it may be lethal due to massive upper gastrointestinal bleeding, while open thoracic surgery is associated with high operative mortality and morbidity. In contrast, thoracic endovascular aortic repair (TEVAR) for AEF is less invasive than open thoracic surgery. Here, we report 3 successful cases of AEF with esophageal carcinoma treated using TEVAR under local anesthesia in the emergent or urgent phase. General condition of all the patients was dramatically improved, but 1 patient with exsanguinations developed infection of the implanted stent-graft and died due to sepsis. The other 2 patients were treated before esophageal bleeding and remained alive for 1 year without infection. The TEVAR should be considered as early as possible in patients with advanced esophageal carcinoma receiving radiation or chemotherapy who develop early signs of AEF such as symptoms of chest discomfort or descending aortic irregularity on computed tomography scan.
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Affiliation(s)
- Noboru Ishikawa
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Showa University, School of Medicine, Tokyo, Japan
| | - Kazuto Maruta
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Showa University, School of Medicine, Tokyo, Japan
| | - Masaya Oi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Showa University, School of Medicine, Tokyo, Japan
| | - Hirofumi Iizuka
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Showa University, School of Medicine, Tokyo, Japan
| | - Hiroyuki Kawaura
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Showa University, School of Medicine, Tokyo, Japan
| | - Tadashi Omoto
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Showa University, School of Medicine, Tokyo, Japan
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Gupta R, Mittal P, Mittal G. Aorto-esophageal fistula secondary to penetrating atherosclerotic ulcer. J Emerg Trauma Shock 2012; 5:262-4. [PMID: 22988408 PMCID: PMC3440896 DOI: 10.4103/0974-2700.99704] [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] [Received: 09/25/2011] [Accepted: 12/22/2011] [Indexed: 11/04/2022] Open
Abstract
Aorto-esophageal fistula (AEF) is a rare and life threatening condition, which can be rapidly fatal. More than half of such cases are secondary to aortic aneurysm rupture. There are only two previous reports describing AEF caused by penetrating atherosclerotic ulcer. We present multidetector computed tomography findings in a case of AEF secondary to penetrating atherosclerotic ulcer.
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Affiliation(s)
- Ranjana Gupta
- Department of Radiodiagnosis, Punjab Institute of Medical Sciences, Jalandhar, Punjab, India
| | - Puneet Mittal
- Department of Radiodiagnosis, Punjab Institute of Medical Sciences, Jalandhar, Punjab, India,Address for correspondence: Dr. Puneet Mittal, E-mail:
| | - Gaurav Mittal
- Department of Medicine, Punjab Institute of Medical Sciences, Jalandhar, Punjab, India
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Ferrero E, Viazzo A, Ferri M, Rocca R, Pecchio A, Piazza S, Cumbo P, Berardi G, Nessi F. Acute Management of Aortoesophageal Fistula and Tracheoesophageal Fistula Treated by Thoracic Endovascular Aortic Repair and Esophageal Endoprosthesis: A Case Misdiagnosed as Esophageal Cancer. Ann Vasc Surg 2011; 25:1142.e1-5. [DOI: 10.1016/j.avsg.2011.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 06/08/2011] [Indexed: 11/25/2022]
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Surgical conversion after thoracic endovascular aortic repair. J Thorac Cardiovasc Surg 2011; 142:1027-31. [DOI: 10.1016/j.jtcvs.2011.01.060] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 01/06/2011] [Accepted: 01/25/2011] [Indexed: 12/23/2022]
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Aortoesophageal fistula after endovascular aortic aneurysm repair of a mycotic thoracic aneurysm. Int J Vasc Med 2011; 2011:649592. [PMID: 21904681 PMCID: PMC3167181 DOI: 10.1155/2011/649592] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 05/05/2011] [Accepted: 06/29/2011] [Indexed: 12/28/2022] Open
Abstract
Mycotic aneurysms constitute a small proportion of aortic aneurysms. Endovascular repair of mycotic aneurysms has been applied with good short-term and midterm results. However, the uncommon aortoenteric fistula formation remains a potentially fatal complication when repairing such infective aneurysms. We present the case of an 80-year-old woman with thoracic and abdominal aortic mycotic aneurysms, which were successfully treated with endografting. However, the patient presented 3 months later with upper gastrointestinal bleeding secondary to erosion of the thoracic graft into the oesophagus. The patient was treated conservatively due to the high risk of surgical repair. There is currently little exposure to the management of mycotic aortic aneurysms. If suspected, imaging of the entire vasculature will aid initial diagnosis and highlight the extent of the disease process, allowing for efficient management. Aortic endografting for mycotic thoracic aneurysms is a high-risk procedure yet is still an appropriate intervention. Aortoenteric fistulae pose a rare but severe complication of aortic endografting in this setting.
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