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Abstract
Background Dysphagia aortica is an umbrella term to describe swallowing obstruction from external aortic compression secondary to a dilated, tortuous, or aneurysmal aorta. We performed a systematic literature review to clarify clinical features and outcomes of patients with dysphagia aortica. Materials and methods We searched PubMed, EMBASE, Web of Science, and the Cochrane Library. The terms “aortic dysphagia,” “dysphagia aortica,” “dysphagia AND aortic aneurysm” were matched. We also queried the prospectively updated database of our esophageal center to identify patients with aortic dysphagia referred for diagnosis and treatment over the past two decades. Results A total of 57 studies including 69 patients diagnosed with dysphagia aortica were identified, and one patient from our center was added to the database. The mean age was 72 years (range 22–98), and the male to female ratio 1.1:1. Of these 70 patients, the majority (n = 63, 90%) had an aortic aneurysm, pseudoaneurysm, or dissection. Overall, 37 (53%) patients received an operative treatment (81.1% a vascular procedure, 13.5% a digestive tract procedure, 5.4% both procedures). Thoracic endovascular aortic repair (TEVAR) accounted for 60% of all vascular procedures. The postoperative mortality rate was 21.2% (n = 7/33). The mortality rate among patients treated conservatively was 55% (n = 11/20). Twenty-six (45.6%) studies were deemed at a high risk of bias. Conclusion Dysphagia aortica is a rare clinical entity with high morbidity and mortality rates and no standardized management. Early recognition of dysphagia and a high suspicion of aortoesophageal fistula may be lifesaving in this patient population.
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Tomforde M, Kupsch H, Christe A, Sturzenegger M, Essig M. Aortic compression of the esophagus: A case report and literature review. Acta Radiol Open 2021; 10:20584601211043256. [PMID: 34603746 PMCID: PMC8481931 DOI: 10.1177/20584601211043256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/11/2021] [Indexed: 11/15/2022] Open
Abstract
Distal aortic compression of the lower esophagus with consecutive dilatation of the proximal esophagus was first described in the literature in 1932. Here, the authors describe the case of a 66 year-old male complaining of gastroesophageal reflux. Due to a positive family history of carcinoma of the esophagus and compression of the dorsal esophagus during an esophageal barium swallow test, further tests were performed. Endoscopy and CT exam revealed a dilated esophagus due to compression of a crossing aorta. Because of mild symptoms and the absence of dysphagia, no further treatment was necessary except for the use of a proton pump inhibitor and recommended follow-ups every one to two years.
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Affiliation(s)
- Manuela Tomforde
- Department of Internal Medicine, Tiefenauspital, Inselgroup of Bern, Bern, Switzerland
- Manuela Tomforde, Department of Internal Medicine, Tiefenauspital, Inselgroup of Bern, Gantrischstrasse 8, Berne CH-3006, Switzerland.
| | - Heidi Kupsch
- Department of Internal Medicine, Tiefenauspital, Inselgroup of Bern, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselgroup, Radiology Division SLS, University of Bern, Bern, Switzerland
| | | | - Manfred Essig
- Department of Internal Medicine, Tiefenauspital, Inselgroup of Bern, Bern, Switzerland
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Meng Z, Pereira M, Sharma A. An 89-year-old man with dysphagia due to an aortic aneurysm and enlarged left atrium. CMAJ 2021; 192:E1539. [PMID: 33229350 DOI: 10.1503/cmaj.200427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ziran Meng
- Departments of Internal Medicine (Meng, Sharma) and Radiology (Pereira), University of Manitoba, Winnipeg, Man.
| | - Michael Pereira
- Departments of Internal Medicine (Meng, Sharma) and Radiology (Pereira), University of Manitoba, Winnipeg, Man
| | - Aditya Sharma
- Departments of Internal Medicine (Meng, Sharma) and Radiology (Pereira), University of Manitoba, Winnipeg, Man
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Meng Z, Pereira M, Sharma A. Dysphagie causée par un anévrisme aortique et une dilatation atriale gauche chez un homme de 89 ans. CMAJ 2021; 193:E261-E262. [PMID: 33593957 PMCID: PMC8034328 DOI: 10.1503/cmaj.200427-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Ziran Meng
- Départements de médecine interne (Meng, Sharma) et de radiologie (Pereira), Université du Manitoba, Winnipeg, Man.
| | - Michael Pereira
- Départements de médecine interne (Meng, Sharma) et de radiologie (Pereira), Université du Manitoba, Winnipeg, Man
| | - Aditya Sharma
- Départements de médecine interne (Meng, Sharma) et de radiologie (Pereira), Université du Manitoba, Winnipeg, Man
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Wada T, Oyama S, Ohuchi S, Kadohama T, Takagi D, Kiryu K, Igarashi I, Yamamoto H. Calcified Aortic Wall Removal for Dysphagia Aortica Caused by Chronic Traumatic Aortic Pseudoaneurysm. Ann Vasc Surg 2021; 74:520.e23-520.e26. [PMID: 33556508 DOI: 10.1016/j.avsg.2021.01.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/01/2021] [Accepted: 01/17/2021] [Indexed: 11/17/2022]
Abstract
In this study, we report a case of a 45-year-old man with dysphagia aortica secondary to chronic traumatic aortic pseudoaneurysm of the aortic isthmus. He had been involved in a motor vehicle accident 27 years earlier. Computed tomography demonstrated a severely calcified aortic pseudoaneurysm of the aortic isthmus that compressed the esophagus extrinsically. An invasive surgical procedure involving a graft replacement and removal of the calcified aortic wall released the esophageal compression and completely improved the patient's symptoms. To the best of our knowledge, a case of dysphagia aortica caused by calcified pseudoaneurysm has never been reported.
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Affiliation(s)
- Takuya Wada
- Department of Cardiovascular surgery, Nakadori General Hospital, Akita, Japan.
| | - Shogo Oyama
- Department of Cardiovascular surgery, Nakadori General Hospital, Akita, Japan
| | - Shingo Ohuchi
- Department of Cardiovascular surgery, Nakadori General Hospital, Akita, Japan
| | - Takayuki Kadohama
- Department of Cardiovascular surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Daichi Takagi
- Department of Cardiovascular surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kentaro Kiryu
- Department of Cardiovascular surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Itaru Igarashi
- Department of Cardiovascular surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Yamamoto
- Department of Cardiovascular surgery, Akita University Graduate School of Medicine, Akita, Japan
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Choi SHJ, Yang GK, Gagnon J. Dysphagia aortica secondary to thoracoabdominal aortic aneurysm resolved after endograft placement. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:501-505. [PMID: 31763508 PMCID: PMC6859279 DOI: 10.1016/j.jvscit.2019.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/16/2019] [Indexed: 11/27/2022]
Abstract
Dysphagia aortica is a rare entity defined as difficulty in swallowing due to external compression by the aorta. Aneurysmal dysphagia aortica successfully treated with thoracic endovascular aortic repair (TEVAR) is exceedingly rare. We report the case of a 74-year-old woman with known thoracoabdominal aneurysm who presented with acute shortness of breath and 3-month history of dysphagia. Computed tomography angiography revealed aneurysmal growth and massive esophageal dilation. She underwent TEVAR and visceral debranching, which led to complete symptom resolution correlated with sac regression. We also present a comprehensive review of the literature with a focus on cases of aneurysmal dysphagia aortica treated with TEVAR.
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Affiliation(s)
- Sally H J Choi
- Division of Vascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gary K Yang
- Division of Vascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Gagnon
- Division of Vascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Papakonstantinou NA, Patris V, Antonopoulos CN, Samiotis I, Argiriou M. Oesophageal necrosis after thoracic endovascular aortic repair: a minimally invasive endovascular approach-a dramatic complication. Interact Cardiovasc Thorac Surg 2019; 28:9-16. [PMID: 29945176 DOI: 10.1093/icvts/ivy193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/18/2018] [Indexed: 11/14/2022] Open
Abstract
There are few cases in the literature reporting dysphagia caused by oesophageal compression by the aorta due to acute or chronic aortic pathology. This type of dysphagia is called dysphagia aortica. Thoracic endovascular aortic repair is nowadays the treatment of choice for anatomically suitable patients experiencing complicated Type B aortic dissection. Oesophageal necrosis is a rare but fatal complication following thoracic endovascular aortic repair. Extrinsic oesophageal compression by the thrombosed aneurysmal sac, a mediastinal haematoma or extensive thrombosis in the false lumen of a dissected aorta and acute vascular occlusion of the oesophageal supply are possible mechanisms. When oesophageal necrosis is suspected, endoscopic examination and computed tomography imaging should be performed repeatedly. Oesophagoscopy will confirm the diagnosis revealing a black, diffusely necrotic and ulcerated oesophageal mucosa. It is critical to intervene before full-thickness oesophageal wall necrosis and mediastinitis occur. Guidelines are absent because of the rarity of this complication. Moreover, lack of a large series does not permit the establishment of guidelines either. However, oesophagectomy of the impaired oesophagus is the only chance for survival. Unfortunately, survival rates are disappointing. Prevention and awareness is the cornerstone of success. Early endoscopic examination when oesophageal necrosis is suspected due to even minimal symptoms will detect this fatal menace on time.
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Affiliation(s)
- Nikolaos A Papakonstantinou
- Department of Cardiovascular and Thoracic Surgery, General Hospital of Athens "Evangelismos", Athens, Greece
| | - Vasileios Patris
- Department of Cardiovascular and Thoracic Surgery, General Hospital of Athens "Evangelismos", Athens, Greece
| | - Constantine N Antonopoulos
- Department of Cardiovascular and Thoracic Surgery, General Hospital of Athens "Evangelismos", Athens, Greece
| | - Ilias Samiotis
- Department of Cardiovascular and Thoracic Surgery, General Hospital of Athens "Evangelismos", Athens, Greece
| | - Mihalis Argiriou
- Department of Cardiovascular and Thoracic Surgery, General Hospital of Athens "Evangelismos", Athens, Greece
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Georgiadis GS, Argyriou C, Koutsoumpelis A, Konstantinou F, Chloropoulou P, Chrisafis I, Souftas V. Revised Endografting for a Giant Descending Thoracic Aorta Aneurysm due to Synchronous Type III/Ib Endoleak, Causing Dysphagia. Ann Vasc Surg 2018; 53:272.e11-272.e17. [PMID: 30081173 DOI: 10.1016/j.avsg.2018.05.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/19/2018] [Accepted: 05/23/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Although surgical resection and graft replacement therapy for thoracic aortic aneurysms has advanced greatly over the last 20 years, significant perioperative morbidity and mortality still occur, particularly in patients considered high risk due to significant coexisting medical illness or previous operations performed for the treatment of intrathoracic disease. METHODS The case described is that of a patient with a giant (13.8 cm) symptomatic descending thoracic aorta aneurysm (DTAA), previously treated endovascularly 15 years ago. The expanding aneurysm was due to undiagnosed synchronous type III/Ib endoleak resulting in chronic malnutrition and eventually dysphagia and dyspnea due to compressive symptoms of the esophagus. Besides the risk of rupture, dyspnea and dysphagia with progressive weight loss were significant indications necessitating repair. Regarding his major comorbidities, the patient was identified as high risk for open surgical repair, therefore an endovascular option was offered. Two valiant tube endografts were inserted and deployed successfully without complications. RESULTS Postoperatively, upper gastrointestinal endoscopy imaging that was performed to the patient revealed marked persistent stenosis of the esophagus despite aneurysm pressure relief. However, at the multidisciplinary team meeting, an esophageal stenting was ruled out due to the risk of stent fracture and esophageal perforation with its devastating complications. Therefore, a conservative management was deemed appropriate for the patient taking into consideration the risks of prolonged hospitalization and malnourishment coupled with an unpredictable clinical course regarding the remission of the symptoms. Despite the slight gradual clinical improvement in the immediate postoperative period, the patient passed away at the 40th postoperative day due to hospital acquired pneumonia. CONCLUSIONS Following endovascular repair of giant DTAA compressing the esophagus, significant symptomatic improvement should not be always expected due to the large residual thrombotic aneurysm sac. Although compression symptoms can be managed conservatively in patients deemed at high risk for esophageal perforation, postoperative course and management is of paramount importance and should be treated on an individual basis.
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Affiliation(s)
- George S Georgiadis
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.
| | - Christos Argyriou
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Andreas Koutsoumpelis
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Fotios Konstantinou
- Department of Cardiothoracic Surgery, "Democritus" University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Pelagia Chloropoulou
- Department of Anesthesiology, "Democritus" University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioannis Chrisafis
- Department of Radiology and Medical Imaging, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Vasileios Souftas
- Department of Radiology and Medical Imaging, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
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Lee FY, Chen WK, Chiu CH, Lin CL, Kao CH, Chen CH, Yang TY, Lai CY. Increased risk of deep vein thrombosis and pulmonary thromboembolism in patients with aortic aneurysms: A nationwide cohort study. PLoS One 2017; 12:e0178587. [PMID: 28591152 PMCID: PMC5462404 DOI: 10.1371/journal.pone.0178587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 05/06/2017] [Indexed: 02/07/2023] Open
Abstract
Studies on the association between aortic aneurysm (AA) and the subsequent risk of venous thromboembolism (VTE) are limited to a few case reports and investigations which only focused on surgical effects. Therefore, we used the National Health Insurance Research Database to clarify whether patients with AAs have a heightened risk of subsequent VTEs, including deep vein thrombosis (DVT) and pulmonary embolism (PE). Our retrospective cohort study comprised patients aged ≥ 18 years who received a diagnosis of an AA and were hospitalized at any point during 2000–2010 (n = 16,630). Each AA patient was frequency-matched to 4 non-AA hospitalized patients based on age, sex, and index year (n = 66,453). The Cox proportional hazard regressions model was used to estimate the adjusted effect of AAs on VTE risk. The overall incidence of DVT and PE was higher in the patients with AA than in the non-AA group patients (23.5 versus 13.2 and 13.5 versus 7.98/1,000 person-years). After adjustment for age, sex, duration of hospitalization in the study period, and comorbidities, patients with AAs were associated with a 1.88-fold higher risk of DVT and 1.90-fold higher risk of PE compared to the non-AA cohort. Patients with abdominal AAs were more likely to develop DVT, whereas thoracic AA patients were more likely to develop PE. A diagnosis of a ruptured AA was associated with a substantially increased risk of DVT. Surgical treatment of AAs was associated with a heightened risk of VTE within 6-months post-operation. Our study demonstrates that AAs are associated with an increased risk of subsequent VTE. Future investigations are encouraged to delineate the mechanisms underlying this association and to evaluate the cost-effectiveness of screening for VTEs in patients with AAs.
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Affiliation(s)
- Feng-You Lee
- Department of Emergency Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Wei-Kung Chen
- Department of Emergency Medicine, Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Hsiang Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Chao-Hsien Chen
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
| | - Tse-Yen Yang
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- * E-mail:
| | - Ching-Yuan Lai
- Department of Emergency Medicine, Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan
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Unnikrishnan M, Pitchai S, Goura P, Savlania A, Sukesan S, Kapilamoorthy T. Dysphagia Aortica: Diagnostic Dilemma and Therapeutic Paradigm. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2016. [DOI: 10.4103/0972-0820.183649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Liao CY, Huang SC, Wang YC, Chin HK, Tsai CC, Ben RJ, Wu HM. Dysphagia aortica: a fatal delay in diagnosis. Am J Emerg Med 2015; 33:1117.e3-5. [PMID: 25701214 DOI: 10.1016/j.ajem.2015.01.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 01/31/2015] [Indexed: 10/24/2022] Open
Abstract
Extrinsic esophageal compression leading to dysphagia is an uncommon and late presentation of large thoracic aortic aneurysm named dysphagia aortica. Herein, we report an 86-year-old man who presented with 1-week duration of chest pain, backache, and dysphagia and was eventually diagnosed as dysphagia aortica. Our patient developed progressive dyspnea due to tracheal compression and failed surgery. The case illustrates the importance of early identification of the rare entity of dysphagia especially in elderly cases with cardiovascular disease with complaint of undetermined dysphagia accompanied with chest pain and backache.
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Affiliation(s)
- Chen-Yi Liao
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
| | - Shih-Chung Huang
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Yi-Chen Wang
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Hsien-Kuo Chin
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chi-Chang Tsai
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Ren-Jy Ben
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Hau-Ming Wu
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
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