Staged Surgical Treatment of Primary Aortoesophageal Fistula

Hwang, Sun Hyun; Cho, Jun Woo; Bae, Chi-Hoon; Jang, Jae Seok

doi:10.5090/kjtcs.2019.52.3.182

Cited by 6 publications

(5 citation statements)

References 4 publications

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“…9 Traditional surgical management consists of open thoracotomy with repair of the aortic lesion and esophagus. 10 However, open surgical repair is associated with significant morbidity and mortality. 10 Endovascular aortic repair through stent-graft placement offers a less invasive option for bleeding control that is particularly useful for patients who are not candidates for open repair.…”

Section: Discussionmentioning

confidence: 99%

Timely Endoscopic Recognition of Aortoesophageal Fistula With Successful Treatment

2023

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Aortoesophageal fistula (AEF) is a devastating cause of upper gastrointestinal bleeding that occurs because of pathologic communication of the esophagus with the aorta. Bleeding AEF has high mortality even with appropriate interventions. In this study, we present a case of a 52-year-old man who presented with hematemesis, which was found to be due to an actively bleeding AEF. Prompt identification of the fistula led to multiple endoscopic interventions that stabilized the patient and allowed him to undergo emergent endovascular aortic stent placement with successful bleeding control.

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Section: Discussionmentioning

confidence: 99%

Timely Endoscopic Recognition of Aortoesophageal Fistula With Successful Treatment

2023

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“…Because AEF is not a common cause of upper gastrointestinal hemorrhage, early diagnosis may be difficult ( Hwang & Cho, 2019 ). Although EGD is useful for the diagnosis of AEFs in patients with gastrointestinal hemorrhage, its diagnosis rate is low at around 25% ( Kayashima et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

“…Although EGD is useful for the diagnosis of AEFs in patients with gastrointestinal hemorrhage, its diagnosis rate is low at around 25% ( Kayashima et al, 2019 ). Also, it should be noted that EGD can irritate blood clots, leading to severe re-hemorrhage ( Hwang & Cho, 2019 ). The characteristic finding of AEF on EGD is a submucosal tumor-like protrusion, ulcerative lesion, or pulsating protrusion with central fistula ( Yang et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

Primary Aortoesophageal Fistula Due to Esophageal Foreign Body: A Case Report

Jin-wen¹,

Shen²

2021

Gastroenterology Nursing

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BackgroundAortoesophageal fistula (AEF) is a rare but life-threatening condition that causes massive gastrointestinal hemorrhage (Lee, Jang, Kim, Cha, & Choi, 2019). It is imperative to recognize these bleeds as early as possible because the reported mortality approaches 77% with intervention and is 100% fatal without treatment (Parikh, Ali, & Wong, 2015;Yang, Hu, & Peng, 2018). Here, we report a case of a 75-year-old man who was diagnosed with a primary AEF due to hematemesis for 4 hours and was successfully treated with intervention. Case PresentationA 75-year-old man was admitted to our hospital because of hematemesis for 4 hours. The patient vomited about 400 ml of bright red blood with clots, accompanied by dizziness and fatigue. He did not have hypertension, coronary heart disease, or diabetes. He was a smoker for 30+ years, smoking five

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“…So antibiotic-soaked prosthetic grafts covered with omental flaps would be an effective alternative, especially when most of the AEF required emergency operations. Esophageal repair of the fistula was another option, especially when esophageal defects were minimal without gross contamination [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

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

Gao

et al. 2020

Gastroenterology Research and Practice

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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.

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Staged Surgical Treatment of Primary Aortoesophageal Fistula

Cited by 6 publications

References 4 publications

Timely Endoscopic Recognition of Aortoesophageal Fistula With Successful Treatment

Timely Endoscopic Recognition of Aortoesophageal Fistula With Successful Treatment

Primary Aortoesophageal Fistula Due to Esophageal Foreign Body: A Case Report

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

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