Retroesophageal subclavian artery—Esophageal fistula: A rare complication of a salivary bypass tube

Abstract

Salivary bypass tubes have been used with great success in preventing neck wound contamination from saliva and decreasing the risk of pharyngoesophageal stenosis. However, complications from esophageal tubes and risk factors for these complications should not be overlooked. Complications can be fatal, as demonstrated in this case of esophageal-subclavian artery fistulization. Retroesophageal subclavian artery (RRESA) is 1 of the most common anatomical variations of the aortic system. Typically producing no symptoms, its discovery is usually coincidental. However, under the right circumstances, this artery can form a fistulous tract. This occurrence has also been documented in cases of long-term nasogastric tube placement and incorrect use of "esophageal" stents. This unique case describes a 62-year-old man who suffered an arterioesophageal fistula during use of a Montgomery salivary bypass tube (MSBT)--a frequently used and exceptionally safe management tool in patients with head and neck cancer.

Anomalous Right Subclavian Artery-Esophageal Fistulae

“…The presence of an aberrant right subclavian artery (ARSA) is the most common aortic arch anomaly, present in 0.2–2.5% of the population [ 4 , 5 ]. The discovery of this variation is usually an incidental finding on imaging studies performed for other reasons, but the anomaly is more prevalent in patients with Down's syndrome and patients with chromosome 22q11 deletions [ 5 – 8 ].…”

Do salivary bypass tubes lower the incidence of pharyngocutaneous fistula following total laryngectomy? A retrospective analysis of predictive factors using multivariate analysis

“…Serious complications from pharyngeal SBT are rare but have been described as a direct result of their use. One patient developed peritonitis and went on to die following migration of the tube into the ileum [47] and arterio-esophageal fistulas have been described, one of which was fatal [48, 49]. However, they are generally safe with only mild complications such as discomfort and granulation tissue formation [43].…”

Stent migration to the ileum—A potentially lethal complication after montgomery salivary bypass tube placement for hypopharyngeal stenosis after laryngectomy

“…6,7 A lethal MSBT-associated fistula from a retroesophageal subclavian artery has also been described. 8 In a review of patients who underwent fasciocutaneous reconstruction of circumferential pharyngoesophageal defects using an anterolateral thigh flap wrapped around an MSBT that was sutured to the tongue base, Murray et al 2 reported MSBT migration into the stomach in 2 of 14 patients. Based on these findings, the authors subsequently sutured the MSBT to a nasogastric tube, which was sutured to the nasal septum.…”