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

Muradi, Akhmadu; Yamaguchi, Masato; Kitagawa, A.; Nomura, Yoshikatsu; Okada, Tomoyo; Okita, Yutaka; Sugimoto, Koji

doi:10.4261/1305-3825.dir.5912-12.1

Cited by 9 publications

(14 citation statements)

References 19 publications

(33 reference statements)

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“…In particular, a single study 14 including patients from multiple centers was excluded from the present review as many of the recruited patients were described previously in separate, more detailed publications with individualized data. Overall, 21 studies 3,4,6,9,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] (six retrospective cohort studies/case series, 15 case reports) with a total of 55 patients with thoracic endograft infection treated with endograft preservation (group A, Tables I and II) and 20 studies 3,5-8, [10][11][12]15,25,26,[32][33][34][35][36][37][38][39][40] (seven retrospective cohort studies/case series, 13 case reports) with a total of Tables III and IV) were included in this review. Demographics and comparisons between the two groups are presented in Table V.…”

Section: Resultsmentioning

confidence: 99%

Comparison of treatment strategies for thoracic endograft infection

Moulakakis

Mylonas

Antonopoulos

et al. 2014

Journal of Vascular Surgery

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Endograft preservation seems not a durable option. It can be offered to patients who refuse surgery or as a palliative option or bridging procedure for severely ill patients. Compared with antibiotic therapy alone, antibiotic therapy followed by drainage and repair of the fistula may control the sepsis, providing, however, mainly a temporary benefit. The presence of fistula is a predictor of dismal outcome. Endograft explantation remains the "gold standard" of treatment. The mortality rate of surgical conversion is much higher in the presence of fistula.

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Section: Resultsmentioning

confidence: 99%

Comparison of treatment strategies for thoracic endograft infection

Moulakakis

Mylonas

Antonopoulos

et al. 2014

Journal of Vascular Surgery

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“…Chiari's triad of chest pain and sentinel hematemesis followed by massive hematemesis has been reported in the literature as a common characteristic presentation in patients with AEF [6, 8–12]. Other less frequent presentations include mediastinitis or fever [4, 10]. One case of AEF with positive blood cultures for Streptococcus viridans has been reported [3] and this case is the second one.…”

Section: Discussionmentioning

confidence: 98%

Atypical Aortoesophageal Fistula with Atypical and Delayed Presentation and Negative Imaging Studies

Hakim

Gjeorgjievski

Garg

et al. 2016

Case Reports in Gastrointestinal Medicine

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A 59-year-old man with past medical history of thoracic aortic aneurysm treated with thoracic endovascular aortic repair presented with melena for 2 weeks. Initial EGD did not reveal the source of bleeding and showed normal esophagus; abdominal arteriogram did not reveal a fistulous communication and initial CTA showed normal position of the aortic graft stent without endoleak. The sixth EGD revealed a submucosal tumor-like projection in the upper esophagus and stigmata of recent bleeding. Another thoracic endovascular aortic repair with stent was placed over the old graft for presumed aortoesophageal fistula. Poststent upper gastrointestinal series with contrast showed extravasation of the contrast from the esophagus and CTA showed fistulous tract between aorta and esophagus. The patient refused definitive surgical repair despite having infected aortic graft; jejunostomy tube was placed and life-long suppressive antibiotic treatment was given and the patient is doing well at 2-year follow-up.

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“…Therefore, most recent studies emphasized the importance of sub-total esophagectomy and ligation of the distal esophagus with a cervical esophagostomy and concomitant gastrostomy or jejunostomy to enable enteral access to bypass the fistula [25,56]. However, such management has a significant mortality of from 25 to 78% due to its massive invasiveness in patients in a physiologically poor condition [21,34,[60][61][62]. Actually, the high rate of mortality and morbidity of this surgical approach might be associated with the nature of emergency surgery to access the damaged aorta in a contaminated field, as well as the need for an invasive procedure, such as thoracic aortic crossclamping or cardio-pulmonary bypass (CPB).…”

Section: Radical Surgical Approachmentioning

confidence: 99%

“…Chiari's triad of mid-thoracic pain and sentinel hematemesis followed by massive hematemesis was reported as the representative symptom of AEF [31][32][33][34][35][36]. In an original study of 500 AEF cases, Hollander and Quick mentioned that hematemesis, chest pain or dysphagia were observed in 63, 58 and 42% of the subjects, respectively [2].…”

Section: Symptom Of Post-tevar Aefmentioning

confidence: 99%

“…While most cases seem to occur within 1-16 months after the TEVAR procedure, Kouritas et al reported one case of AEF that developed 6 years after TEVAR [38]. Other less frequent presentations of post-TEVAR AEF were dysphagia due to extra-luminal compression of the esophageal wall or highgrade fever due to mediastinitis, infection of the surgical/ endovascular graft or sepsis [22,34,35]. A recent review revealed that hematemesis, hypovolemic shock or systemic infection were observed in 86.1, 60.9 or 21.7% of 72 patients with post-TEVAR AEFs, respectively [28].…”

Section: Symptom Of Post-tevar Aefmentioning

confidence: 99%

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

Cited by 9 publications

References 19 publications

Comparison of treatment strategies for thoracic endograft infection

Comparison of treatment strategies for thoracic endograft infection

Atypical Aortoesophageal Fistula with Atypical and Delayed Presentation and Negative Imaging Studies

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

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