Successful management of concomitant aortoesophageal and aortotracheal fistulae secondary to a thoracic aortic aneurysm: Case report and review of literature

Abstract

Thoracic aortic aneurysm with fistulization into the trachea or the esophagus is usually a lethal complication. An unusual case of combined aortotracheal and aortoesophageal fistulae is presented here. The patient had a successful outcome after resection of the aneurysm with tracheal repair and esophageal resection. A review of literature on this subject is also included in this manuscript.

Endovascular treatment of aortoesophageal and aortobronchial fistulae

“…Nevertheless, they present many similar features in terms of etiology, pathogenesis, presentation, and natural history, and they occasionally occur together. 24 In our study, no significant differences in terms of perioperative and late mortality were observed between AEF and ABF. The endovascular procedure in case of ABF presented with increased procedural times and blood loss.…”

Adult Aortotracheal Fistula as Sequela of Double Aortic Arch Repair in Infancy: A Case Report

“…Fistulae between the aorta and the tracheobronchial tree have historically been described in adults as rare complications of infections, thoracic cavity surgery, radiation to the chest, prolonged intubation, tracheal reconstruction, and abdominal aortic aneurysms. 5,7,13-15 These fistulae most frequently form between the left main bronchi and the aorta. 16,17 It is important for clinicians to be aware of this potentially catastrophic condition.…”

Unexpectedly large aortoesophageal fistula inconsistent with CT imaging due to the thrombus working as the tamponade

“…In short, the thrombus works like a tamponade [5]. Additionally, the fistula becomes larger with repeated dislodgement of clots [6]. When the patient has high blood pressure, the thrombus will be pushed out from the fistula and subsequently the fatal exsanguination will occur.…”

“…Regarding the outcome of surgical intervention, depending on the size of AEF and whether gross contamination is present, esophagectomy eliminating new infectious source of the mediastinum and prosthetic graft [6,8] and in situ replacement of the aortic aneurysm using prosthetic graft are the preferable procedures after debridement and removal of devitalized tissues, subsequently, abundant irrigation of mediastinum and protection of the prosthesis using variable pedicle flap such as the greater omentum [9]. Without gross contamination, primary closure of the esophageal fistula may be possible [2].…”