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(8): 233-237 [PMID: 27574612 DOI: 10.12998/wjcc.v4.i8.233]
Corresponding Author of This Article
Dr. Graham Roche-Nagle, Assistant Professor, Division of Vascular Surgery, Toronto General Hospital, 200 Elizabeth St. Toronto M5G 2C4, Ontario, Canada. graham.roche-nagle@uhn.ca
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 16, 2016; 4(8): 233-237 Published online Aug 16, 2016. doi: 10.12998/wjcc.v4.i8.233
Secondary aorto-esophageal fistula after thoracic aortic aneurysm endovascular repair treated by covered esophageal stenting
Mary Tao, Eran Shlomovitz, Gail Darling, Graham Roche-Nagle
Mary Tao, Graham Roche-Nagle, Division of Vascular Surgery, Toronto General Hospital, Toronto M5G 2C4, Ontario, Canada
Eran Shlomovitz, Department of Interventional Radiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto M5G 2C4, Ontario, Canada
Gail Darling, Department of Thoracic Surgery, Toronto General Hospital, Toronto M5G 2C4, Ontario, Canada
Author contributions: Tao M and Roche-Nagle G wrote the manuscript; Shlomovitz E and Darling G were involved in editing the manuscript; Roche-Nagle G designed the study.
Institutional review board statement: Researchers are advised to consult with the REB when uncertainty exists and when formal and systematic collection of human subjects’ research will be occurring.
Informed consent statement: The patient has died no consent obtained.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Graham Roche-Nagle, Assistant Professor, Division of Vascular Surgery, Toronto General Hospital, 200 Elizabeth St. Toronto M5G 2C4, Ontario, Canada. graham.roche-nagle@uhn.ca
Telephone: +1-416-3405332 Fax: +1-416-3405029
Received: February 22, 2016 Peer-review started: February 23, 2016 First decision: March 25, 2016 Revised: April 15, 2016 Accepted: June 14, 2016 Article in press: June 16, 2016 Published online: August 16, 2016 Processing time: 172 Days and 20.2 Hours
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.
Core tip: Thoracic endovascular aortic repair (TEVAR) 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. Aortoesophageal fistula post-TEVAR is a very rare entity; however, it is a devastating and usually fatal condition. Treatment options are very restricted, as these patients are often not candidates for complex surgery. We consider the placement of a covered self-expanding esophageal stent to be useful in the management of secondary aortoesophageal fistula after TEVAR to prevent re-bleeding in the fragile patient.
