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Aortoesophageal fistula: review of trends in the last decade. Surg Today 2019; 50:1551-1559. [PMID: 31844987 DOI: 10.1007/s00595-019-01937-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/18/2019] [Indexed: 12/11/2022]
Abstract
We reviewed articles on aortoesophageal fistula (AEF) published between January, 2009 and December, 2018. Postoperative aortic disease was the most common cause of AEF, followed by primary aortic aneurysm, bone ingestion, and thoracic cancer. Thoracic endovascular aortic repair (TEVAR) was the most common initial therapy for primary aortic disease, rather than graft replacement. Secondary AEF developed between 1 and 268 months, and between 1 and 11 months after the initial therapy for aortic disease and thoracic cancer, respectively. TEVAR trended to be preferred over surgery for aortic lesions because of its minimal invasiveness and certified hemostasis. In contrast, esophagectomy was preferred for esophageal lesions to remove the infectious source. A combination of surgery for the aorta (TEVAR, graft replacement or repair) and esophagus (esophagectomy, esophageal stent or repair) was usually adopted. Each graft replacement or esophagectomy was associated with a favorable prognosis for aortic or esophageal surgery, and the combination of graft replacement and esophagectomy generally improved the prognosis remarkably. Antibiotic therapy was given to 65 patients, with 20 receiving multiple antibiotics aimed at strong effects and the type of antibiotic described as broad-spectrum in 29 patients. Meropenem, vancomycin, and fluconazole were the most popular antibiotics used to prevent graft or stent infection. In conclusion, graft replacement and esophagectomy can achieve a favorable prognosis for patients with AEF, but strong, broad-spectrum antibiotic therapy might be required to prevent sepsis after surgery.
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Kamigaichi A, Hamai Y, Emi M, Ibuki Y, Takahashi S, Katayama K, Furukawa T, Okada M. Three-step surgical treatment of aortoesophageal fistula after thoracic endovascular aortic repair: A case report. Int J Surg Case Rep 2019; 65:221-224. [PMID: 31733619 PMCID: PMC6864132 DOI: 10.1016/j.ijscr.2019.10.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/28/2019] [Accepted: 10/26/2019] [Indexed: 11/18/2022] Open
Abstract
The number of aortoesophageal fistula (AEF) after thoracic endovascular aortic repair (TEVAR) is recently increasing due to the spread of TEVAR. AEF is a rare but fatal disease, and only surgery can save the life of patients with AEF after TEVAR. The therapeutic strategy for AEF after TEVAR remains controversial. The three-step surgical approach described herein could be a useful therapeutic option for AEF after TEVAR.
Introduction Aortoesophageal fistula (AEF) is a fatal complication results in sudden massive hematemesis. Although thoracic endovascular aortic repair (TEVAR) is an established method of treating aortic aneurysms or aortic dissection, the number of AEF after TEVAR is recently increasing due to the spread of TEVAR. However, the therapeutic strategy for AEF remains controversial. Presentation of case We describe a 71-year-old man with Stanford B aortic dissection and aortic aneurysm rupture treated by TEVAR who developed AEF between the thoracic aorta and upper thoracic esophagus 20 months thereafter. We applied a three-step surgical procedure for this patient comprising resection of the esophagus as the infectious source, removal of an aortic aneurysm with stent-graft and replacement of the aorta, and final reconstruction of the esophagus. Thereafter, the patient resumed oral intake and has remained relapse-free for 24 months without adverse events. Discussion Previous reports have described simultaneous resection of the esophagus and aortic stent-graft via a left thoracotomy followed by a two-step surgical reconstruction of the esophagus. We applied a three-step procedure consisting of resections of the esophagus and aortic stent-graft on separate occasions followed by esophageal reconstruction in this patient. The first procedure in the three-step approach is less stressful than that of the two-step approach. Conclusion The three-step surgical approach to treating AEF after TEVAR resulted in a good outcome for this patient. Thus, this surgical strategy is a useful option for treating AEF after TEVAR.
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Affiliation(s)
| | - Yoichi Hamai
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
| | - Manabu Emi
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yuta Ibuki
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Graduate School of Medicine, Hiroshima University, Hiroshima, Japan
| | - Keijiro Katayama
- Department of Cardiovascular Surgery, Graduate School of Medicine, Hiroshima University, Hiroshima, Japan
| | - Tomokuni Furukawa
- Cardiovascular Center, Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
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Rawala MS, Badami V, Rizvi SB, Nanjundappa A. Aortoesophageal Fistula: A Fatal Complication of Thoracic Endovascular Aortic Stent-Graft Placement. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1258-1261. [PMID: 30348937 PMCID: PMC6206620 DOI: 10.12659/ajcr.911441] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Patient: Female, 80 Final Diagnosis: Aortoesophageal fistula Symptoms: Hematemesis Medication: — Clinical Procedure: Thoracic endovascular aortic repair Specialty: General and Internal Medicine
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Affiliation(s)
- Muhammad Shabbir Rawala
- Department of Internal Medicine, West Virginia University (WVU) - Charleston Division, Charleston, WV, USA
| | - Varun Badami
- Department of Internal Medicine, West Virginia University (WVU) - Morgantown Division, Morgantown, WV, USA
| | - Syed Bilal Rizvi
- Department of Cardiology, Rapides Regional Medical Center, Alexandria, LA, USA
| | - Aravinda Nanjundappa
- Department of Cardiology and Vascular Surgery, West Virginia University (WVU) - Charleston Division, Charleston, WV, USA
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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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Tao M, Shlomovitz E, Darling G, Roche-Nagle G. Secondary aorto-esophageal fistula after thoracic aortic aneurysm endovascular repair treated by covered esophageal stenting. World J Clin Cases 2016; 4:233-237. [PMID: 27574612 PMCID: PMC4983695 DOI: 10.12998/wjcc.v4.i8.233] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 04/15/2016] [Accepted: 06/16/2016] [Indexed: 02/05/2023] Open
Abstract
Thoracic endovascular aortic repair for thoracic aortic aneurysms is an accepted alternative to open surgery, especially in patients with significant comorbidities. The procedure itself has a low risk of complications and fistulas to surrounding organs are rarely reported. An 86-year-old patient was admitted to our hospital with gastro intestinal (GI) bleeding and a suspected aortoesophageal fistula. Eight months prior, the patient had undergone a stent graft repair of a mycotic thoracic aneurysm. Computerized tomography angiography and upper GI endoscopy confirmed an aortoesophageal fistula, which was treated by esophageal stenting. With early recognition, esophageal stenting may have a role in the initial emergency control of bleeding from and palliation of aortoesophageal fistula.
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Töpel I, Zorger N, Steinbauer M. Inflammatory diseases of the aorta: Part 2: Infectious aortitis. GEFASSCHIRURGIE 2016; 21:87-93. [PMID: 27546993 PMCID: PMC4974295 DOI: 10.1007/s00772-016-0142-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Infectious aortitis is a rare but life-threatening disease. Due to impending local and systemic complications, prompt diagnosis and initiation of effective causal treatment are essential for patient survival. Differentiating infectious aortitis from other aortic diseases, in particular non-infectious aortitis, is of great importance. This article discusses the various causes, diagnostic tools, and therapeutic strategies for infectious aortitis.
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Affiliation(s)
- I. Töpel
- Klinik für Gefäßchirurgie, KH Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049 Regensburg, Deutschland
| | - N. Zorger
- Institut für Radiologie, Neuroradiologie und Nuklearmedizin, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland
| | - M. Steinbauer
- Klinik für Gefäßchirurgie, KH Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049 Regensburg, Deutschland
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Vitor S, Meireles L, Lopes J, Ribeiro LC, Velosa J. Secondary Aortoesophageal Fistula Due to Thoracic Aortic Stent Graft: Is There a Role for Endoscopic Intervention? GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:128-129. [PMID: 28868392 PMCID: PMC5580158 DOI: 10.1016/j.jpge.2015.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/03/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Sofia Vitor
- Gastroenterology and Hepatology Department, Hospital Santa Maria - Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Liliane Meireles
- Gastroenterology and Hepatology Department, Hospital Santa Maria - Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - João Lopes
- Gastroenterology and Hepatology Department, Hospital Santa Maria - Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Luís Carrilho Ribeiro
- Gastroenterology and Hepatology Department, Hospital Santa Maria - Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - José Velosa
- Gastroenterology and Hepatology Department, Hospital Santa Maria - Centro Hospitalar Lisboa Norte, Lisbon, Portugal
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Xi EP, Zhu J, Zhu SB, Zhang Y. Secondary aortoesophageal fistula after thoracic aortic aneurysm endovascular repair: literature review and new insights regarding the hypothesized mechanisms. Int J Clin Exp Med 2014; 7:3244-3252. [PMID: 25419355 PMCID: PMC4238538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/15/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Endovascular aortic repair was first performed nearly two decades ago and has become a well-established alternative therapy for many thoracoabdominal aortic diseases. Early survival results with the endovascular aortic repair were impressive, but it also brought many complications. Aortoesophageal fistula is little-known and may be underestimated because it is an unusual complication of thoracic endovascular aortic repair. OBJECTIVE To provide a review of the general features of aortoesophageal fistula as a little-known complication after thoracic endovascular aortic repair and to present a new insight regarding the hypothesized mechanisms of this complication based on clinical experience. METHODS The new insights regarding the hypothesized mechanisms built on the literature review and clinical experience. Literature Review from PubMed and Web of Knowledge for relevant studies with English paper. Searches were performed without year, and used the combinations of the following key words: "thoracic aortic aneurysm", "endovascular", "aortoesophageal fistula", "complication". RESULTS The authors' hypothesized mechanisms of aortoesophageal fistula after thoracic aortic aneurysm endovascular repair include the relatively thin vessel wall on thoracic aortic aneurysm hard to prevent the relatively rigid stent graft projecting the aortic and direct erosion into the esophagus. CONCLUSION Selecting flexibility and appropriate size stent graft, avoiding the thin aortic wall, and identifying the risk factors may reduce the morbidity of complications with aortoesophageal fistula after thoracic aortic aneurysm endovascular repair.
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Affiliation(s)
- Er-Ping Xi
- Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of Guangzhou Command Wuhan, 430070, Hubei Province, People's Republic of China
| | - Jian Zhu
- Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of Guangzhou Command Wuhan, 430070, Hubei Province, People's Republic of China
| | - Shui-Bo Zhu
- Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of Guangzhou Command Wuhan, 430070, Hubei Province, People's Republic of China
| | - Yu Zhang
- Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of Guangzhou Command Wuhan, 430070, Hubei Province, People's Republic of China
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Moulakakis KG, Sfyroeras GS, Mylonas SN, Mantas G, Papapetrou A, Antonopoulos CN, Kakisis JD, Liapis CD. Outcome After Preservation of Infected Abdominal Aortic Endografts. J Endovasc Ther 2014; 21:448-55. [DOI: 10.1583/13-4575mr.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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A case of secondary aortoesophageal fistula inserted a covered self-expanding esophageal stent to control gastrointestinal bleeding. Case Rep Gastrointest Med 2013; 2013:857135. [PMID: 23781353 PMCID: PMC3679725 DOI: 10.1155/2013/857135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 05/09/2013] [Indexed: 12/31/2022] Open
Abstract
A 73-year-old man presented with melena. After a thorough workup including esophageal endoscopy, computed tomography scans, and esophagography, the diagnosis of secondary aortoesophageal fistula was made. Two years previously, he had undergone endovascular stent-graft repair for the dissection of his descending thoracic aorta. Because of the generally poor condition of the patient and the high risk of any aggressive surgical intervention, we inserted a covered self-expanding esophageal stent on postadmission day 18. Esophagography after insertion did not show any evidence of a leak of contrast medium. Despite treatment with antibiotics, he developed sepsis and expired on day 52, but rebleeding did not occur in this period. We consider insertion of a covered self-expanding esophageal stent as a feasible option in the management of secondary aortoesophageal fistula in high-risk patients.
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Chiba D, Hanabata N, Araki Y, Sawaya M, Yoshimura T, Aoki M, Shimoyama T, Fukuda S. Aortoesophageal fistula after thoracic endovascular aortic repair diagnosed and followed with endoscopy. Intern Med 2013; 52:451-5. [PMID: 23411700 DOI: 10.2169/internalmedicine.52.9139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 70-year-old man reported dysphagia two months after undergoing thoracic endovascular aortic repair (TEVAR). An endoscopic examination revealed a fistula between the esophagus and the thoracic aortic aneurysm, and computed tomography (CT) showed that the thoracic aortic aneurysm had increased in size. The patient was diagnosed with an aortoesophageal fistula (AEF), and surgical replacement of the thoracic aorta was performed. AEFs are a rare but typically fatal complication after TEVAR. Physicians should consider a diagnosis of AEF and perform endoscopic examinations and CT in patients who undergo TEVAR and subsequently complain of dysphagia.
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Affiliation(s)
- Daisuke Chiba
- Department of Gastroenterology, Hirosaki University Graduate School of Medicine, Japan
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