|
1
|
Chen J. Vascular covered stent and video-assisted thoracoscopic surgery for Aortoesophageal fistula caused by esophageal fishbone: a case report. J Cardiothorac Surg 2024; 19:112. [PMID: 38461352 PMCID: PMC10924337 DOI: 10.1186/s13019-024-02610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/05/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare condition characterized by communication between the aorta and esophagus. AEF caused by an esophageal foreign body is even rare, and there is currently no recommended standard treatment protocol. We report a case of delayed aortic rupture after the endoscopic removal of a fish bone, which was successfully treated with a combined approach of vascular stenting and thoracic surgery. CASE PRESENTATION A 33-year-old man presented to the hospital after experiencing chest discomfort for 3 days following the accidental ingestion of a fish bone. Under endoscopic guidance, the fish bone was successfully removed, and the patient was subsequently admitted for medical therapy. On the fourth postoperative day, the patient suddenly developed hematemesis, and chest computed tomography angiography revealed the presence of an AEF. This necessitated urgent intervention; hence, thoracic surgery was performed and a vascular-covered stent was placed. Following the surgical procedure, the patient received active medical treatment, recovered well, and was successfully discharged from the hospital. CONCLUSIONS In patients with esophageal perforation caused by foreign bodies, hospitalization for observation, computed tomography angiography examination, early use of antibiotics, and careful assessment of aortic damage are advised. Thoracic endovascular aortic repair and esophageal rupture repair may have benefits for the treatment of AEF.
Collapse
Affiliation(s)
- Jianfeng Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, No 37 Guoxue Alley, Wuhou District, Chengdu City, Sichuan Province, PR China.
| |
Collapse
|
|
2
|
Rey Chaves CE, Rojas S, Rosso JD, Peláez M, Sánchez EF, Hernández Rodríguez OG. Aortoesophageal fistulae following TEVAR: Case report and literature review. Int J Surg Case Rep 2023; 106:108126. [PMID: 37058806 PMCID: PMC10130615 DOI: 10.1016/j.ijscr.2023.108126] [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: 11/17/2022] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
INTRODUCTION Aortoesophageal fistulae are an uncommon pathology, primarily due to the aortic pathology in more than 50 % of the cases, followed by foreign body ingestion, and advanced malignancies. Recently it is recognized after surgical management of thoracic aortic pathologies either open or endovascular, with increased rates of morbidity and mortality. PRESENTATION OF THE CASE We present a 62-year-old male patient with a previous history of thoracic endovascular aortic repair, who enters the emergency room with gastrointestinal bleeding and clinical signs of infection. Positive blood cultures, and tomographic signs include prosthetic gas, with endoscopic findings of aortoesophageal fistulae. Aggressive surgical management was performed including esophageal resection and gastrointestinal exclusion. Bleeding control was reached in the early postoperative period, nevertheless despite multidisciplinary management, the patient died 8 days after surgery. CLINICAL DISCUSSION Aortoesophageal fistulae, remains to be an uncommon complication either of thoracic aortic aneurysm or after endovascular treatment of aortic aneurysm; with high rates of morbidity and mortality, should be suspected in every case with upper gastrointestinal bleeding in the context of a patient with aortic disease. Non-surgical management should be avoided due to the high risk of complications and mortality, aggressive management needs to be considered in each case according to clinical condition of the patient. CONCLUSION Aortoesophageal fistulae remain an uncommon complication after TEVAR, with increased mortality and morbidity rates after complete treatment. Conservative management should be avoided to achieve bleeding control and prevent the extension of the infection.
Collapse
Affiliation(s)
- Carlos Eduardo Rey Chaves
- Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia; Estudiante de posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina. Bogotá - Colombia.
| | - Santiago Rojas
- Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia; Estudiante de posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina. Bogotá - Colombia
| | - J D Rosso
- Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia
| | - Mauricio Peláez
- Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia; Cirugía de Tórax, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia
| | - Elio Fabio Sánchez
- Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia; Cirugía General y Cirugía Oncológica. Coordinador Unidad Cirugía Oncológica. Profesor asistente Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia
| | - Oscar Geovanny Hernández Rodríguez
- Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia; Cirugía vascular periférica, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia
| |
Collapse
|
|
3
|
Tabaku K, Schizas N, Patris V, Argiriou M. Delayed simultaneous aortoesophageal and aortobronchial fistulae post thoracic endovascular aortic repair (TEVAR). Indian J Thorac Cardiovasc Surg 2023; 39:53-56. [PMID: 36590042 PMCID: PMC9794656 DOI: 10.1007/s12055-022-01422-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/07/2022] Open
Abstract
Aortoesophageal and aortobronchial fistulae after thoracic endovascular aortic repair (TEVAR) are rare and life-threatening conditions. No clear guidance exists in the literature for the optimal therapeutic management of such cases. This case demonstrates a delayed simultaneous aortoesophageal and aortobronchial fistulae treated conservatively with culture-guided antibiotic therapy and combined endovascular management.
Collapse
Affiliation(s)
- Kate Tabaku
- Cardiovascular and Thoracic Surgery Department, Evangelismos General Hospital, Ipsilantou 45-47, Attiki, 10676 Athens, Greece
| | - Nikolaos Schizas
- Cardiovascular and Thoracic Surgery Department, Evangelismos General Hospital, Ipsilantou 45-47, Attiki, 10676 Athens, Greece
| | - Vasilis Patris
- Cardiovascular and Thoracic Surgery Department, Evangelismos General Hospital, Ipsilantou 45-47, Attiki, 10676 Athens, Greece
| | - Mihalis Argiriou
- Cardiovascular and Thoracic Surgery Department, Evangelismos General Hospital, Ipsilantou 45-47, Attiki, 10676 Athens, Greece
| |
Collapse
|
|
4
|
Aorticoesophagal Fistula Combined with Upper Gastrointestinal Bleeding after Endovascular Dissection of Thoracic Aortic Aneurysm. Diagnostics (Basel) 2022; 13:diagnostics13010040. [PMID: 36611331 PMCID: PMC9818726 DOI: 10.3390/diagnostics13010040] [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: 12/08/2022] [Revised: 12/17/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Aortoesophageal fistula (AEF) is a relatively rare and potentially fatal disease. Secondary AEF is rare but is associated with serious complications and high mortality. There are rare cases of esophageal mediastinal fistula after descending aortic aneurysm stent implantation. We report the case of a 76-year-old man who had upper abdominal distension, without obvious inducement, for 3 months and felt fullness after a meal, accompanied by anorexia. A chest computer tomography (CT) examination of the abdomen was performed with the outside hospital. Descending thoracic aortic aneurysm was discovered and was treated with stent implantation. The patient was transferred to our hospital to continue treatment, mainly because of an esophageal mediastinal fistula. Finally, the thoracic aortic aneurysm was diagnosed as AEF after stent implantation, combined with the diagnosis of upper gastrointestinal bleeding. We hope that, through this case, we can explain the possible causes of bronchial mediastinal fistula after stent implantation of descending aortic aneurysm and the mechanism of upper gastrointestinal bleeding.
Collapse
|
|
5
|
Donato F, Boskoski I, Vincenzoni C, Montanari F, Tinelli G, Donati T, Tshomba Y. A New Mini-Invasive Approach for a Catastrophic Disease: Staged Endovascular and Endoscopic Treatment of Aorto-Esophageal Fistulas. J Pers Med 2022; 12:1735. [PMID: 36294876 PMCID: PMC9605668 DOI: 10.3390/jpm12101735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/01/2022] [Accepted: 10/18/2022] [Indexed: 08/10/2023] Open
Abstract
Aorto-esophageal fistula (AEF) is an uncommon but usually fatal disorder. Surgery with resection of an aneurysm and esophagus, in situ reconstruction of the descending aorta and omental flap installation offers the gold standard for the reduction of infections, but it is burdened by high intraoperative and perioperative mortality rates. We report our experience with a combined minimally invasive approach for the multi-stage treatment of three cases of aorto-esophageal fistula caused by thoracic aneurysm rupture. In all of the patients, the aneurysm was treated with thoracic endovascular aortic repair and the esophageal lesion was treated with esophageal endoprosthesis placement. According to our experience, the combined strategy of thoracic endovascular aortic repair (TEVAR) and esophageal less invasive endoscopic treatments represents an alternative solution in frail patients with high surgical risk.
Collapse
Affiliation(s)
- Federica Donato
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ivo Boskoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Claudio Vincenzoni
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesca Montanari
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanni Tinelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Tommaso Donati
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| |
Collapse
|
|
6
|
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: 0.3] [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.
Collapse
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
| |
Collapse
|
|
7
|
Ndikumana R, Lal A, Herath J. Aortoesophageal Fistula Secondary to Esophageal Diverticulum Resulting in Sudden Unexpected Death. Acad Forensic Pathol 2021. [DOI: 10.1177/19253621211038122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aortoesophageal fistula (AEF) is a rarely encountered clinical outcome that is often fatal. It is most commonly a postoperative complication of vascular surgery (secondary AEF). Reported primary causes of AEF include aortic aneurysm, atherosclerosis, infection, foreign objects, achalasia with megaesophagus, gastrointestinal malignancy, and radiotherapy. Aortoesophageal fistula is often not a top diagnostic consideration for clinicians or pathologists and has the potential to be overlooked. This report describes a rare case of AEF secondary to an esophageal traction diverticulum and associated abscess that resulted in the sudden unexpected death of a 78-year-old male. Aortoesophageal fistula is an important consideration for pathologists and requires careful consideration in the postmortem setting.
Collapse
|
|
8
|
Deshpande AA, Khurana R, Shaw M, Kumar S. Aorto-oesophageal fistula post-thoracic endovascular repair of type B aortic dissection: an uncommon catastrophic complication. BMJ Case Rep 2021; 14:e243379. [PMID: 34404653 PMCID: PMC8382045 DOI: 10.1136/bcr-2021-243379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Amit Ajit Deshpande
- Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Rishabh Khurana
- Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Shaw
- Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
|
9
|
Furui M, Hirata H, Kakii B, Yoshida T. Secondary aorto-esophageal fistula treated by covered esophageal stent and muscle wrapping. Ann Thorac Surg 2021; 112:e241-e243. [PMID: 33549522 DOI: 10.1016/j.athoracsur.2021.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 11/19/2022]
Abstract
Secondary aorto-esophageal fistula is rare, but associated with serious complications and high mortality. We devised a treatment strategy involving a covered esophageal stent, instead of esophageal resection, and placing the latissimus dorsi muscle around the infected aorta without removing the aorta and the stent graft. A 72-year-old man with a history of total arch replacement with a frozen elephant trunk for a thoracic dissecting aneurysm developed aorto-esophageal fistula and underwent surgical treatment using our strategy. He recovered well, and there is no evidence of re-infection 6 months after surgery. This strategy may be a less invasive surgical option.
Collapse
Affiliation(s)
- Masato Furui
- Cardiovascular Surgery Department, Matsubara Tokushukai Hospital, Osaka, Japan.
| | - Hirohisa Hirata
- Surgery Department, Matsubara Tokushukai Hospital, Osaka, Japan
| | - Bunpachi Kakii
- Cardiovascular Surgery Department, Matsubara Tokushukai Hospital, Osaka, Japan
| | - Takeshi Yoshida
- Cardiovascular Surgery Department, Matsubara Tokushukai Hospital, Osaka, Japan
| |
Collapse
|
|
10
|
Popova IE, Danielian SN, Pogodina AN, Chernaia NR, Muslimov RS, Mironov AV, Kokov LS. [Peculiarities of diagnosis and emergency surgical care in aorto-oesophageal fistula]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:108-114. [PMID: 33063757 DOI: 10.33529/angiq2020303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An aorto-oesophageal fistula is a rare but life-threatening pathological condition developing on the background of diseases of the aorta and oesophagus, as well as after surgical interventions on the aorta. The article deals with a clinical case report regarding management of a patient presenting with an aorto-oesophageal fistula resulting from a thoracic artery aneurysm. The main clinical manifestations of the diseases included dysphagia (due to oesophageal obstruction caused by thrombotic masses of the aneurysm) and the occurring gastrointestinal haemorrhage. Comprehensive instrumental diagnosis was performed using roentgen examination of the oesophagus, oesophagoscopy, and contrast-enhanced computed tomography of the chest. The obtained findings made it possible to objectively assess the patient's state, to carry out timely treatment in conditions of a surgical hospital, and to avoid severe complications.
Collapse
Affiliation(s)
- I E Popova
- Department of Radiodiagnosis, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - Sh N Danielian
- Department of Thoracoabdominal Surgery, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - A N Pogodina
- Department of Thoracoabdominal Surgery, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - N R Chernaia
- Department of Radiodiagnosis, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - R Sh Muslimov
- Department of Radiodiagnosis, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - A V Mironov
- Department of Emergency Surgery, Endoscopy and Intensive Therapy, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - L S Kokov
- Department of Radiodiagnosis, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia; Department of Radiodiagnosis of the Institute of Professional Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| |
Collapse
|
|
11
|
Kubesch A, Waidmann O, Blumenstein I, Bechstein WO, Friedrich-Rust M, Jung M, Albert J, Hausmann J. A Single-Center Case Series of Endoscopically Treated Aorto-Gastrointestinal Fistula after Endovascular Aortic Repair: Surgery Is Still the Only Valid Solution. Visc Med 2020; 37:134-141. [PMID: 33981754 DOI: 10.1159/000507821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/09/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction Aortoesophageal fistula (AEF) is a life-threatening complication associated with endovascular aortic repair (EVAR) and occurs mostly in patients who undergo thoracic EVAR (TEVAR). To date, surgical treatment of AEF has been considered the most promising therapeutic approach. New endoscopic techniques could contribute to the therapy of AEF. The aim of this study was to analyze the outcome after endoscopic treatment of EVAR-associated AEF. Methods All patients who received endoscopic diagnostics and/or therapy for AEF after EVAR/TEVAR in our center between 2010 and 2019 were evaluated. Results Seven suitable patients were included. Six of them had undergone TEVAR and 1 had EVAR. Fistula occurred at an average of 307 days (range 21-2,774 days) post-EVAR. Endoscopic treatment was performed on 4 patients by using an over-the-scope clip (OTSC®). However, fistula recurred in all patients who were initially treated endoscopically. They were then treated either by sequential application of further OTSCs® or by implantation of a fully coated, self-expanding metal stent. One of these patients underwent a partial esophageal resection in a subsequent treatment approach. All patients died during the observational period, 5 as a direct consequence of the AEF/aortoduodenal fistula and 2 due to comorbidities. The median survival time after fistula occurrence was 120 days (range 5-823 days). Conclusion Endoscopic treatment of AEF with OTSC® should be considered as a possible interim solution, especially in patients with severe comorbidities. However, surgical remediation still appears to be the only procedure with intermediate to long-term therapeutic success.
Collapse
Affiliation(s)
- Alica Kubesch
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Oliver Waidmann
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Irina Blumenstein
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Wolf Otto Bechstein
- Department of General and Visceral Surgery, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Michael Jung
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Jörg Albert
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany.,Department of Internal Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Johannes Hausmann
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany.,Department of Gastroenterology, St. Vinzenz-Hospital Hanau, Hanau, Germany
| |
Collapse
|
|
12
|
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: 49] [Impact Index Per Article: 8.2] [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.
Collapse
|
|
13
|
Zhan Y, Xu Z. Massive hemorrhage from an aortoesophageal fistula caused by esophageal stent implantation: A case report and literature review. Medicine (Baltimore) 2019; 98:e18303. [PMID: 31860979 PMCID: PMC6940160 DOI: 10.1097/md.0000000000018303] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
RATIONALE Aortoesophageal fistula (AEF) is the direct communication between the aorta and esophagus, which can cause fatal hemorrhage, and its incidence increased with the use of an esophageal stent (ES). PATIENT CONCERNS A 79-year-old man was admitted due to hemodynamic shock with massive hematemesis caused by AEF 1 month after the implantation of an ES. DIAGNOSES Computed tomography angiography visualized an AEF with an ulcer-like projection on the aortic arch where the ES was placed. Angiography of the aorta revealed extravasation of contrast media from the aortic arch into the stented esophagus, which confirmed the diagnosis. INTERVENTIONS Thoracic endovascular aortic repair (TEVAR) was performed for massive hematemesis caused by ES-related, AEF but did not solve the underlying problem, leading to the second fatal hemorrhage. LESSONS TEVAR for the unique treatment of ES-related AEF is feasible in certain cases but may lead to collapse after a specific period.
Collapse
|
|
14
|
Murphy B, Azarbal A, Schenning RC, Bensch K, Sukumar M, Stelzer K, Nabavizadeh N. Prophylactic Aortic Stent Prevents Massive Hemorrhage and Hematemesis After Definitive Esophageal Chemoradiation in a Patient With Pretreatment Aortic Involvement. Pract Radiat Oncol 2019; 9:e447-e451. [PMID: 31128306 DOI: 10.1016/j.prro.2019.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/27/2019] [Accepted: 05/13/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Blair Murphy
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Amir Azarbal
- Department of Surgery, Division of Vascular Surgery, Portland VA Medical Center, Portland, Oregon
| | - Ryan C Schenning
- Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon
| | - Kenneth Bensch
- Department of Hematology and Oncology, Portland VA Medical Center, Portland, Oregon
| | - Mithran Sukumar
- Department of Surgery, Division of Thoracic Surgery, Portland VA Medical Center, Portland, Oregon
| | - Keith Stelzer
- Celilo Cancer Center, Mid-Columbia Medical Center, The Dalles, Oregon
| | - Nima Nabavizadeh
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon.
| |
Collapse
|
|
15
|
Stanger E, Johnson AM, Juneja Mucci J. Novel Management of an Aortoesophageal Fistula Prior to Definitive Surgical Repair. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2019; 12:1179547619839710. [PMID: 31040731 PMCID: PMC6480989 DOI: 10.1177/1179547619839710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 11/16/2022]
Abstract
An aortoesophageal fistula (AEF) is a rare but often fatal complication associated with the placement of an aortic stent graft such as those utilized in thoracic endovascular aortic repair (TEVAR) procedures. Definitive surgical repair of AEF is the treatment of choice, as conservative management is nearly always fatal. We present the case of an AEF in a 74-year-old male managed by a unique treatment method; an esophageal stent was deployed to cover the fistula as a temporizing measure prior to definitive surgical correction, thus allowing time for resuscitation and hemodynamic optimization. The use of esophageal stents in the setting of AEF following TEVAR has been previously reported in the literature as a palliative measure for patients deemed incapable of tolerating open repair surgery. Our case demonstrates a new and innovative approach to the management of AEF following TEVAR in which the use of esophageal stenting is expanded beyond the role of palliative care and should be considered as a means to optimize at-risk patients prior to definitive corrective surgery in the hopes of improving outcomes.
Collapse
Affiliation(s)
- Evan Stanger
- Surgical Intensive Care Unit, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Angela M Johnson
- Surgical Intensive Care Unit, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Joti Juneja Mucci
- Surgical Intensive Care Unit, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|
|
16
|
Two autopsy cases of rupture of the aorta by fistula formation after thoracic endovascular aortic repair and open stent-grafting on aortic arch aneurysm. Cardiovasc Pathol 2019; 39:61-66. [DOI: 10.1016/j.carpath.2018.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 11/22/2022] Open
|
|
17
|
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: 30] [Impact Index Per Article: 3.8] [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.
Collapse
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
| |
Collapse
|
|
18
|
Bohórquez Lozano M, Vélez Ruíz J, Vélez AM. Fístula aortoesofágica. COLOMBIA FORENSE 2017. [DOI: 10.16925/cf.v4i1.1960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Introducción: la fístula aortoesofágica ( FAE ) es considerada una entidad rara, con alta letalidad, que suele presentarse como una muerte súbita en la mayoría de los casos, esto motiva la investigación judicial y la autopsia médico-legal. El propósito de esta presentación de caso fue enfatizar los hallazgos de autopsia en esta causa de muerte, lo que permite a los médicos rurales o peritos forenses buscar y reconocer los criterios morfológicos macroscópicos de la FAE y así realizar un diagnóstico preciso ante esta entidad.
Métodos y materiales: revisión de la información escrita, realización de disección estándar que por los hallazgos ameritó la revisión completa y detallada del bloque cardiopulmonar y gastrointestinal en conjunto.
Historia del caso: se presenta el caso de un hombre de 53 años que fallece súbitamente después de evento hematemético. En la autopsia se evidencia una FAE por úlcera perforante de la pared anterior de la aorta descendente, debido a una placa ateromatosa complicada. Se analizan los diferentes procesos etiopatogénicos y los procedimientos de autopsia que llevan a esta conclusión.
Resultados y discusión: se reporta en este caso una FAE , la muerte se produce por choque hipovolémico asociado a insuficiencia respiratoria por broncoaspiración hemática y, etiológicamente, se identifica una placa ateromatosa complicada con úlcera y ruptura hacia el esófago, que se corresponde con las causas frecuentes de los reportes mundiales.
Conclusión: la FAE debe sospecharse en casos de muerte súbita con antecedentes de hematemesis y distensión hemática gástrica al momento de la autopsia.
Collapse
|