Thoracic Endovascular Aortic Repair in Management of Aorto-oesophageal Fistulas: a Case Series

Overview

Journal Eur Heart J Case Rep

Publisher Oxford University Press

Specialty Cardiology & Vascular Diseases

Date 2020 Nov 18

PMID 33204973

Citations 1

Authors

Rajesh Vijayvergiya

Ganesh Kasinadhuni

Saroj Kant Sinha

Thakur Deen Yadav

Harkant Singh

Ajay Savlania

Anupam Lal

Kewal Kanabar

Affiliations

Soon will be listed here.

Abstract

Background: Aorto-oesophageal fistula (AOF) is a rare, catastrophic disease with an extremely poor prognosis. A ruptured thoracic aortic aneurysm is a common aetiology for AOF. The clinical presentation is usually massive haematemesis and collapse. Timely diagnosis and appropriate treatment are crucial in managing AOF.

Case Summary: We hereby report two cases of AOF, who underwent successful emergency thoracic endovascular aortic repair (TEVAR) to control active bleed and exsanguination. Case 1, an elderly lady with atherosclerotic aneurysm had TEVAR followed by open surgery for oesophageal rent and necrosed left main bronchus. Case 2 had mycotic tubercular aneurysm who later had infected graft-stent following TEVAR.

Discussion: Open surgery is the conventional treatment for AOF; however, TEVAR can be an alternative and less invasive approach in selected high-risk patients. Various management issues related to TEVAR with AOF have been discussed in the article.

Citing Articles

Therapeutic effectiveness of tuberculous aneurysm and risk factors for mortality: a systematic review.

Yi S, Sheng L, Li W Gen Thorac Cardiovasc Surg. 2022; 70(6):515-525.

PMID: 35378674 PMC: 9135858. DOI: 10.1007/s11748-022-01811-9.

References

Yeow Y, Fong S, Rao J, Sim R . Aorto-oesophageal fistula from miliary tuberculosis: a rare cause of massive haematemesis. Ann Acad Med Singap. 2014; 43(11):559-60. View

Topel I, Stehr A, Steinbauer M, Piso P, Schlitt H, Kasprzak P . Surgical strategy in aortoesophageal fistulae: endovascular stentgrafts and in situ repair of the aorta with cryopreserved homografts. Ann Surg. 2007; 246(5):853-9. DOI: 10.1097/SLA.0b013e3180caa3c9. View

Canaud L, Ata Ozdemir B, Wynter Bee W, Bahia S, Holt P, Thompson M . Thoracic endovascular aortic repair in management of aortoesophageal fistulas. J Vasc Surg. 2013; 59(1):248-54. DOI: 10.1016/j.jvs.2013.07.117. View

Jonker F, Schlosser F, Moll F, van Herwaarden J, Indes J, Verhagen H . Outcomes of thoracic endovascular aortic repair for aortobronchial and aortoesophageal fistulas. J Endovasc Ther. 2009; 16(4):428-40. DOI: 10.1583/09-2741R.1. View

Chiesa R, Melissano G, Marone E, Kahlberg A, Marrocco-Trischitta M, Tshomba Y . Endovascular treatment of aortoesophageal and aortobronchial fistulae. J Vasc Surg. 2010; 51(5):1195-202. DOI: 10.1016/j.jvs.2009.10.130. View

Hollander J, Quick G . Aortoesophageal fistula: a comprehensive review of the literature. Am J Med. 1991; 91(3):279-87. DOI: 10.1016/0002-9343(91)90129-l. View

Canaud L, DAnnoville T, Ata Ozdemir B, Marty-Ane C, Alric P . Combined endovascular and surgical approach for aortobronchial fistula. J Thorac Cardiovasc Surg. 2014; 148(5):2108-11. DOI: 10.1016/j.jtcvs.2014.01.018. View

Setacci C, Chisci E, Setacci F, Ercolini L, De Donato G, Troisi N . How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair. Aorta (Stamford). 2016; 2(6):255-64. PMC: 4682678. DOI: 10.12945/j.aorta.2014.14-036. View

Lau H . Dysphagia aortica: harbinger of aortoesophageal fistula?. Surgery. 2001; 129(6):763-4. DOI: 10.1067/msy.2001.109496. View

10.

Kieffer E, Chiche L, Gomes D . Aortoesophageal fistula: value of in situ aortic allograft replacement. Ann Surg. 2003; 238(2):283-90. PMC: 1422695. DOI: 10.1097/01.sla.0000080828.37493.e0. View

11.

Heckstall R, Hollander J . Aortoesophageal fistula: recognition and diagnosis in the emergency department. Ann Emerg Med. 1998; 32(4):502-5. DOI: 10.1016/s0196-0644(98)70182-9. View

12.

Saito A, Motomura N, Hattori O, Kinoshita O, Shimada S, Saiki Y . Outcome of surgical repair of aorto-eosophageal fistulas with cryopreserved aortic allografts. Interact Cardiovasc Thorac Surg. 2012; 14(5):532-7. PMC: 3329282. DOI: 10.1093/icvts/ivr154. View

13.

Lyons O, Patel A, Saha P, Clough R, Price N, Taylor P . A 14-year experience with aortic endograft infection: management and results. Eur J Vasc Endovasc Surg. 2013; 46(3):306-13. DOI: 10.1016/j.ejvs.2013.04.021. View

14.

Lawrie G, Earle N, DE BAKEY M . Evolution of surgical techniques for aneurysms of the descending thoracic aorta: twenty-nine years experience with 659 patients. J Card Surg. 1994; 9(6):648-61. DOI: 10.1111/j.1540-8191.1994.tb00899.x. View

15.

Byard R . Lethal aorto-oesophageal fistula - characteristic features and aetiology. J Forensic Leg Med. 2013; 20(3):164-8. DOI: 10.1016/j.jflm.2012.06.008. View