Risk Factors for Mortality in Patients with Aortoesophageal Fistula Related to Aortic Lesions

Abstract

Objective. Aortoesophageal fistula (AEF) related to aortic aneurysm and dissection is an uncommon but life-threatening condition. We performed a systematic review of risk factors for mortality and factors associated with the prognosis of AEF. Methods. A systematic search of the PubMed, Embase, and Cochrane Library databases was performed. Clinical characteristics, diagnostic methods, and treatments were assessed in terms of their ability to predict mortality. Results. The systematic review identified 184 eligible articles including 219 patients with AEF. Multivariable Cox regression revealed positive correlations of hemorrhagic shock (hazard ratio (HR): 1.824, 95% CI: 1.217-2.735, P=0.004), sepsis (HR: 1.714, 95% CI: 1.112-2.641, P=0.015), multiorgan failure (HR: 3.060, 95% CI: 1.470-6.368, P=0.003), and conservative treatment (HR: 5.257, 95% CI: 3.405-8.116, P<0.001) with mortality and a negative correlation between combination therapy (aortic graft replacement and esophagectomy) and mortality (HR: 0.319, 95% CI: 0.125-0.813, P=0.017). Kaplan–Meier survival analysis showed that the 1-year cumulative survival rate was 42.5±3.8%. The overall fistula-related mortality rate was 47.0% (103/219). The most common causes of death were bleeding (54.9%) and infection (29.2%). Conclusions. We found that hemorrhagic shock, sepsis, and multiorgan failure were risk factors for death in patients with AEF. Additionally, conservative treatment was associated with a higher rate of mortality, while combined aortic graft replacement and esophagectomy improved the prognosis.

Case report: Aortoesophageal fistula—an extremely rare but life-threatening cardiovascular cause of hematemesis

“…Surgical treatment options of AEF include open surgery and thoracic endovascular aortic repair (TEVAR); the latter is a minimally invasive technique which deploys an endoluminal aortic stent to rapidly control the bleeding with a favorable 30-day mortality rate of 27.5% ( 18 , 19 ). TEVAR however does not address the esophageal lesion in AEFs, which may form a nidus for infections and subsequently lead to stent graft infection, mediastinitis, sepsis, re-hemorrhage, and stroke ( 20 , 21 ).…”

The effect of aortic esophageal fistula treatment after TEVAR with artificial vessel bypass（Single center clinical experience）

“…However, after deployment of the internal graft, some patients are at risk of uncontrollable mediastinal infection and death. Most scholars believe that open surgery is the root treatment of AEF [2][3][4][5] .. Aortic replacement combined with esophagectomy and debridement at the same time or in stages is an effective treatment, but complications such as hemorrhage and sepsis may occur [6][7][8] .…”

“…According to literature reports, the incidence of AEF (aortic esophageal fistula) after TEVAR is 1.9%, but the condition is dangerous and complicated, and the mortality rate is high [1] . For AEF after TEVAR, most scholars believe that open surgery is the root treatment of AEF [2][3][4][5] . Aortic replacement combined with esophagectomy and debridement at the same time or by stages is an effective treatment, but complications such as hemorrhage and sepsis may occur [6][7][8] .…”

Dual-modality emergency management of a rare cause of an aorto-oesophageal fistula: a case report

“…Aorto-oesophageal fistula (AOF) usually results in fatal upper gastro-intestinal (UGI) haemorrhage, despite developments in treatment [ 1 ]. Causes of AOF include thoracic aortic aneurysm, malignancy and foreign body ingestion.…”

“…Since 1994, the advent of thoracic endovascular aortic repair (TEVAR) has revolutionized the condition’s management [ 2 ]. In-hospital mortality of AOF can be up to 42% without treatment and 28.2% after treatment with TEVAR [ 1 ].…”