Endovascular treatment of thoracic aortic fistulas

Therapeutic strategy for treating aortoesophageal fistulas

“…In our study, twenty-three patients underwent TEVAR as first-line treatment for bleeding of the thoracic aorta, most of whom were successfully treated for thoracic aortic bleeding in the short term of the acute phase. However, in addition to that observed in the currently reported series, the poor late results of a TEVAR alone strategy have been reported in most cases due to infectious complications or recurrent fatal bleeding [13,[19][20][21]. In this series, the use of TEVAR did not improve the mortality rates at 6 or 18 months.…”

“…With the growing number of interventional thoracic aortic procedures and increases in the length of follow-up periods, late complications of TEVAR have become increasingly evident over time, including postprocedural AEF [9][10][11][12]. TEVAR has been proposed to be an alternative strategy to surgical management [13][14][15]. Although less invasive, this technique presents important limitations in treating AEF, primarily due to the risk of graft contamination.…”

“…This is due to the rarity of the condition, the relatively recent clinical introduction of the endovascular technique, the lack of large surveys and late results in the literature. More recently, some authors have reported mid-term results suggesting that TEVAR may be used as a ''bridge'' to open surgery of the thoracic aorta and esophagus [13,[19][20][21].…”

Aortoesophageal Fistula Secondary to Placement of an Esophageal Stent: Emergent Treatment with Cyanoacrylate and Endovascular Stent Graft

“…Previous reports recommend prompt open surgical repair or emergent endovascular stent graft. [6][7][8][9][10][11][12][13][14][15] An AEF caused by an esophageal stent is extremely rare. Only a few cases have been reported, and there was only one case of successful surgical repair of AEF with patient survival (Table I).…”

“…Endovascular aortic stent graft placement is a safe and effective method of rapidly controlling acute bleeding from an AEF. [9][10][11][12][13][14][15] However, endovascular stent graft placement is a longer procedure than NBCA embolization, because of the time required for arteriotomy of the femoral artery and placement of the stent graft itself. Massive, life-threatening bleeding from the aorta is a time-critical condition, and this case report suggests that NBCA embolization of the fistula can be performed more quickly, within several minutes, and is particularly beneficial for patients with hypovolemic shock.…”