Percutaneous Treatment of an Infected Aneurysmal Sac Secondary to Aortoesophageal Fistula with a History of Stent-Graft Treatment for Thoracic Aortic Aneurysm

Numan, Fürüzan; Gülşen, Fatih; Cantasdemir, Murat; Solak, Serdar; Arbatlı, Harun

doi:10.1007/s00270-011-0256-1

Cited by 11 publications

(16 citation statements)

References 13 publications

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“…Aortoesophageal fistula is a very rare condition and is more often secondary to esophageal cancer, trauma, presence of a foreign body, or erosion of a vascular graft into the esophagus, or less commonly primarily caused by a thoracic artery MA or thoracic artery infection. 256,262 These represent <10% of all aortoenteric fistulae and occur in 1.9% of patients who undergo TEVAR for treatment of thoracic artery aneurysm. 213,231,241,244,256,262 Either primary or secondary aortoenteric fistula is a highly lethal condition with a 100% mortality rate if not diagnosed and treated promptly.…”

Section: Additional Factors In Management Of Aortic Mamentioning

confidence: 99%

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

373

307

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The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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Section: Additional Factors In Management Of Aortic Mamentioning

confidence: 99%

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

373

307

View full text Add to dashboard Cite

show abstract

“…Kasai et al reported a case of post-TEVAR AEF with advanced hepatocellular carcinoma that survived after conservative management alone without TEVAR for 14 months after the initial bleeding event [76]. Numan et al described a case of post-TEVAR AEF related to an infected aneurysm that was treated by CT-guided insertion of a drainage catheter [77]. Burks Jr. et al suggested in their seven-case series that the combination therapy of TEVAR followed by long-term anti-biotic treatment and percutaneous drainage might be a safe method [42,78].…”

Section: Palliative Treatment For Aefmentioning

confidence: 99%

Management of aorto-esophageal fistula secondary after thoracic endovascular aortic repair: a review of literature

Uno

Koike

Takahashi

et al. 2017

Clin J Gastroenterol

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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-gastroduodenoscopy 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.Keywords Aorto-esophageal fistula Á Thoracic endovascular aortic repair Á Thoracic aortic aneurysm Á Endoscopy Á Surgery Abbreviations

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“…Approximately 24 cases of secondary AEF have been previously reported in the literature (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), with most (54.2%) occurring within four months after TEVAR with various types of endograft, and only six patients (25%) surviving, with a mean followup period of 11.6 months (Table).…”

mentioning

confidence: 99%

“…Thus, we postulate that the combination of these two mechanisms might be the cause of AEF. Some reports described how these mechanisms induce an inflammatory process, adhesion, and tissue necrosis, leading to erosion and finally to fistulation, with subsequent massive hematemesis when the fistula reached the proximal or distal aspect of the endograft (1,17).…”

mentioning

confidence: 99%

“…On the other hand, as most AEF patients have contraindications to open surgery, owing to their poor general condition or comorbidities, surgical therapy is not frequently undertaken, as was the case with our patient. CT-guided percutaneous drainage may have several benefits (17) to release the compression and to identify the exact organism that caused infection for selection of the appropriate antibiotic. In our case, combining conservative management with CT-guided percutaneous drainage of the infected aneurysm sac as a bridging management could have improved the patient outcome.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Secondary aortoesophageal fistula after thoracic endovascular aortic repair for a huge aneurysm: case report and review of the literature

Muradi

Yamaguchi

Kitagawa

et al. 2012

Diagn Interv Radiol

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Percutaneous Treatment of an Infected Aneurysmal Sac Secondary to Aortoesophageal Fistula with a History of Stent-Graft Treatment for Thoracic Aortic Aneurysm

Cited by 11 publications

References 13 publications

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Management of aorto-esophageal fistula secondary after thoracic endovascular aortic repair: a review of literature

Secondary aortoesophageal fistula after thoracic endovascular aortic repair for a huge aneurysm: case report and review of the literature

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