Is endovascular stent grafting for descending thoracic aortic disease recommendable in patients with dysphagia?

Abstract

ndoluminal stent graft repair is an alternative to conventional surgical intervention. Perioperative complications associated with the endoluminal technique are arterial injury, maldeployment, aortic perforation, left upper limb ischemia, and paraplegia. Secondary complications are leaking, graft migration, aortoesophageal fistula, and aortobronchial fistula. 1 There are various conditions associated with aortoesophageal fistula: foreign bodies, malignancy, primary fistula of thoracic aortic aneurysm, or secondary fistula after surgical repair of these aneurysms. 2 We report 2 cases of an uncommon condition: aortoesophageal fistula after stenting of a descending thoracic aneurysm and of a spontaneous aortic rupture with a periaortic hematoma.

An Unusual Case of Dysphagia After Endovascular Exclusion of Thoracoabdominal Aortic Aneurysm

“…These positive prognostic factors, however, along with a variety of changes in the aortic contour, may occasionally add mechanical stress to the esophageal wall, leading to severe and possibly lethal adverse events, such as esophageal wall erosion and fistulization. 6 Early esophageal complications after stentgraft deployment are rare, and the etiology remains uncertain. Chuter et al 3 described a patient who developed similar clinical features, with endoscopy positive for achalasia.…”

Cardiovascular dysphagia — anatomical and clinical implications

“…Endovascular aortic repair was once successful with gradually alle-viated symptoms and disappearance of oesophageal obstruction evidenced by follow-up barium study [15]. However, endovascular stenting may leave the periaortic haematoma or the intra-aneurysmal thrombosis in situ, which may still compress the oesophagus even after the procedure, and thus may potentially result in oesophageal ischaemia [25].…”

Tracheo-Bronchial Obstruction and Esophageal Perforation after TEVAR for Thoracic Aortic Rupture

“…When such a radical procedure seems too risky, conservative treatment is considered. [1][2][3][4][5][6] Although several reports have described the successful conservative treatment of AEF, endovascular stenting in a potentially contaminated or infected lesion is still controversial. 2,10) In this case, we initially selected conservative treatment because the patient's general condition was poor and there was no evidence of sepsis, resorting to urgent surgery only after laboratory data showed increasing inflammatory reaction.…”

“…Although TEVAR has been developed as a safe and less-invasive treatment option for patients at high risk for conventional surgical repair, [1][2][3] it may not have any advantages with respect to the risk of AEF. 1,6) Caution and diligent monitoring after surgery, especially in emergent procedures, is therefore suggested.…”

“…1,3) Despite improvements in endovascular treatment, esophageal perforation remains a fatal complication. [1][2][3][4][5][6] Therefore, early detection and effective therapeutic management are critical.…”