A fistula formation between the esophagus and an aberrant right subclavian artery is a rare but fatal complication that has been mostly described in the setting of prolonged nasogastric intubation and foreign body erosion. We report a case of a young morbidly obese patient who underwent sleeve gastrectomy that was complicated by a postoperative leak at the level of the gastroesophageal junction. A covered esophageal stent was placed endoscopically to treat the leak. The patient developed massive upper gastrointestinal bleeding secondary to the erosion of the stent into an aberrant retroesophageal right subclavian artery twelve days after stent placement. She was ultimately treated by endovascular stenting of the aberrant right subclavian artery followed by thoracotomy and esophageal repair over a T-tube. This case report highlights the multidisciplinary approach needed to diagnose and manage such a devastating complication. It also emphasizes the need for imaging studies prior to stent deployment to delineate the vascular anatomy and rule out the possibility of such an anomaly in view of the growing popularity of esophageal stents, especially in the setting of a leak.
Although initial enthusiasm laparoscopic aortic surgery and MIAS have failed to gain acceptance in the vascular surgery community due to intrinsic procedural challenges, they are currently practiced in few highly specialized centers. At this moment, high-quality evidence is lacking regarding the further feasibility of these techniques and their applicability in general practice compared to endovascular therapies. While the ABF remains still the optimal choice in select, fit for surgery patients, endovascular therapies offer a less invasive approach that may provide a mortality and morbidity benefit in higher risk patients with acceptable short- and long-term outcomes.
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