Primary Aortoenteric Fistula: Part I

Dossa, Christos D.; Pipinos, Iraklis I.; Shepard, Alexander D.; Ernst, Calvin B.

doi:10.1007/bf02133413

Cited by 57 publications

(38 citation statements)

References 24 publications

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“…While secondary AEF is defined as AEF that occurs after aortic reconstructive surgery with prosthetic grafts, others are assumed to represent the primary AEF. The incidence of the former was reported to be as high as 1.6%, while those of the latter were much rarer [14,15].…”

Section: Etiologies Of Aorto-esophageal Fistulamentioning

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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Section: Etiologies Of Aorto-esophageal Fistulamentioning

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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“…Sie werden nach der Lokalisation der Verbindung in Anastomosenfisteln und transprothetische Arrosionsblutungen unterschieden. Die primären Formen dagegen entstehen heutzutage überwiegend auf dem Boden arteriosklerotischer Baucharterienaneurysmen [7]. Mit der Einführung der Antibiotikatherapie wurden die frü-her noch häufig zu beobachtenden primären Fisteln durch Infektionen wie Syphilis, Tuberkulose, Salmonellose oder andere mykotische Erreger weitgehend zurückgedrängt [29].…”

Section: Schlüsselwörterunclassified

“…Die Angiographie führt nur in ca. 13% der Fälle zur korrekten Diagnose, da der Nachweis einer Fistel nur bei aktiver Blutung möglich ist [7]. Insgesamt werden die Möglichkeiten einer weiterführenden Diagnostik von der Klinik des Patienten bestimmt.Bei schwerer Blutung und vitaler Bedrohung stellt nach wie vor die chirurgische Intervention die einzige sinnvolle Maßnahme dar.…”

Section: Diagnoseunclassified

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Primäre aortoduodenale Fistel als Spätkomplikation nach paraaortaler Radiatio Ein Fallbericht

Drognitz

Pfeiffenberger

Schareck

et al. 2002

Chirurg

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Primary aortoenteric fistulae (AEFs) are rare vascular entities. More than 75% of primary AEFs involve the duodenum, with the overwhelming majority located in the third or fourth portion. Atherosclerosis, leading to formation of an aortic aneurysm, remains the most common etiology, accounting for more than 3/4 of the cases reported. Primary aortoenteric fistulae following radiotherapy are rare. The case of a 49-year-old man with aortoduodenal fistula 22 years after para-aortic radiation is presented. In November 1997, the patient suddenly developed hematemesis and melena. Endoscopy suggested the presence of an ulcus but no definitive bleeding source could be seen. Bleeding stopped spontaneously. Six hours later he developed massive hematemesis and was transferred to our department. An emergency operation was performed. We found an aorto-duodenal fistula in the third portion of the duodenum without an aortic aneurysm. We directly sutured the aortic wall laceration and resected the third and fourth part of the duodenum. Histology revealed typical signs of radiation damage. The patient is alive and well 2 years after surgery. To our knowledge, this is the sixth case of a primary aorto-duodenal fistula following radiotherapy ever to be reported in world literature.

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“…В литературе описаны ПАЭФ между аортой и тонкой кишкой (тощей, подвздошной -10%), толстой кишкой (6%), желудком (4%) [16,21,30]. Также встречаются слу-чаи ПАЭФ при язвенной болезни желудка, псевдотумо-розном панкреатите и кистах поджелудочной железы, ди-вертикулите, аппендиците и радиационных поражениях [4,7,18,22,26,27]. Зарегистрирован случай двух одно-временно существующих ПАЭФ у одного пациента [28].…”

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Aorto-femoral replacement in patient with infrarenal aortic aneurysm and primary aorto-duodenal fistula

Belov¹,

Виноградов²,

Komarov³

et al. 2015

Kardiol. serdechno-sosud. khir.

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Primary Aortoenteric Fistula: Part I

Cited by 57 publications

References 24 publications

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

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

Primäre aortoduodenale Fistel als Spätkomplikation nach paraaortaler Radiatio Ein Fallbericht

Aorto-femoral replacement in patient with infrarenal aortic aneurysm and primary aorto-duodenal fistula

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