Dysphagia aortica secondary to thoracoabdominal aortic aneurysm resolved after endograft placement

Choi, Sally H.J.; Yang, Gary K.; Gagnon, Joël

doi:10.1016/j.jvscit.2019.08.008

Cited by 13 publications

(12 citation statements)

References 12 publications

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“…In symptomatic cases, patients might complain of chest or back pain, or symptoms related to compression of the surrounding structures (trachea, bronchus, esophagus, superior vena cava, left and right atrium or pulmonary veins). [3][4][5] In our patient, the recent worsening of symptoms suggested rapid dilatation of the aneurysm, necessitating urgent surgical intervention. Therefore, we were unable to perform further evaluation, including a pressure study before surgery.…”

Section: Discussionmentioning

confidence: 76%

Compression of the Left Atrium and Left Ventricle by a Thoracoabdominal Aortic Aneurysm: A Case Report

Nagaya

Naganuma

Kudoh

et al. 2020

Annals of Vascular Diseases

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We describe the case of a 66-year-old man with a thoracoabdominal aortic aneurysm, who presented with cardiac failure; he had complained of shortness of breath. A contrast-enhanced computed tomography scan and transthoracic echocardiography showed compression of the left atrium and ventricle by a giant thoracoabdominal aortic aneurysm. The cardiac failure resolved after early prosthetic graft replacement surgery.

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Section: Discussionmentioning

confidence: 76%

Compression of the Left Atrium and Left Ventricle by a Thoracoabdominal Aortic Aneurysm: A Case Report

Nagaya

Naganuma

Kudoh

et al. 2020

Annals of Vascular Diseases

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“…For patients who are not a candidate for surgery, thoracic aortic stent repair or thoracic endovascular aortic repair (TEVAR) [13,14] or a percutaneous endoscopic gastrostomy tube should be considered [13]. Hybrid stenting therapy is another treatment option for dysphagia aortica due to a thoracic aortic aneurysm.…”

Section: Figurementioning

confidence: 99%

Dysphagia Aortica: A Case Report and Review of Treatment Options

Baboli¹,

Mittal²

2021

OBM Geriatrics

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A 64-year-old, cachectic man with body mass index (BMI) <19 visited in clinic with the chief complaint of dysphagia for 6 months. He reported a 2-year history of reflux and heartburn, for which he has been taking pantoprazole but reported only 40% relief of reflux symptoms. He reported progressive solid food mid-chest dysphagia. Additional comorbidities included severe pulmonary bronchiectasis and bullous emphysema and a history of treated pulmonary tuberculosis 40 years prior and two previous episodes of spontaneous pneumothorax in the right-sided lung treated with a chest tube. A chest X-ray showed a calcified aorta crossing the midline (Figure 1). A CT scan done for assessment of pneumothorax showed a torturous descending thoracic aorta and a dilated mid-/proximal esophagus. The diameter of the descending aorta was 41 mm, and it crossed the midline. For evaluation of dysphagia, a barium swallow was performed, which showed a narrowing in the mid-esophagus with proximal dilation and lack of peristalsis (Figure 2). Upper gastrointestinal endoscopy showed a dilated esophagus with eccentric extraluminal compression. High-resolution manometry (HRM) showed an absence of peristalsis and a vascular pressure artifact around the mid-esophagus correlating with the external aortic compression (Figure 3). Due to alarming weight loss and a BMI <19, we recommended a feeding jejunostomy to maintain nutrition before scheduling definitive treatment.

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“…Dysphagia arises when the aorta pushes the esophagus anterolaterally and against the crural diaphragm. Primary aortoesophageal fistula (AEF) is the most feared complication [ 7 ], typically in the setting of untreated thoracic aortic aneurysm (TAA) that occurs in 5–10 per 100,000 person years [ 8 ]. This may be asymptomatic and diagnosed incidentally, or it may present with symptoms due to mediastinal compression or with dissection or rupture in the worst-case scenario.…”

Section: Introductionmentioning

confidence: 99%

Dysphagia aortica

et al. 2021

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Summary 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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Dysphagia aortica secondary to thoracoabdominal aortic aneurysm resolved after endograft placement

Cited by 13 publications

References 12 publications

Compression of the Left Atrium and Left Ventricle by a Thoracoabdominal Aortic Aneurysm: A Case Report

Compression of the Left Atrium and Left Ventricle by a Thoracoabdominal Aortic Aneurysm: A Case Report

Dysphagia Aortica: A Case Report and Review of Treatment Options

Dysphagia aortica

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