Aberrant Right Subclavian Arterioesophageal Fistula: Endovascular Occlusion via a Transbrachial Approach

An aberrant right subclavian artery (ARSA) is a common aortic arch abnormality. A case of a 57-year-old man presenting with melena and hypotension secondary to an ARSA-esophageal fistula is reported. The current report is unique because it is the first reported case of ARSA-esophageal fistula associated with prior esophagectomy and gastric pull-up. A MedLine search was performed for ARSA-esophageal fistula cases, which were then compared with the present case. Because this patient had no vascular conduits, nasogastric or endotracheal tubes, the fistula likely occurred secondary to the previous surgery. This case is unusual because the patient survived the original hemorrhage associated with the ARSA-esophageal fistula. An ARSA-esophageal fistula is a rare, but potentially fatal cause of upper gastrointestinal bleeding. A high index of suspicion is needed to make the diagnosis. This condition should be considered in patients with risk factors combined with hemodynamically significant gastrointestinal bleeding.

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“…A literature search only revealed 13 documented cases of ARSA-esophageal fistulas. With the exception of two cases, all were fatal (1,3).…”

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confidence: 83%

Upper Gastrointestinal Bleeding Secondary to an Aberrant Right Subclavian Artery-Esophageal Fistula: A Case Report and Review of the Literature

Millar

Rostom

Rasuli

et al. 2007

Canadian Journal of Gastroenterology

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“…13,14 As a consequence, endovascular stent-grafting has become an alternative treatment option, which might reduce mortality and morbidity. 15 To the authors' knowledge, the outcome of patients treated for an ASA have thus far only been presented as case reports or small case series. 9 The aim of this report is to present experience with 10 patients with symptomatic ASA and aneurysm of the ASA who underwent surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Symptomatic Aberrant Subclavian Arteries

Jalaie

Grommes

Sailer

et al. 2014

European Journal of Vascular and Endovascular Surgery

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“…The most common etiology for development of ARSA-esophageal fistula appeared to be secondary to compression, friction, or pressure necrosis from recent instrumentation with an endotracheal tube, nasogastric tube, or tracheostomy tube, seen in 14 of the 33 summarized cases. 14,15,17,19,21,22,24,27,29,31,[38][39][40][41] Fistula development from prior placement of esophageal stent was noted in 5 cases. 34,36,42,43 Other reported causes for fistula formation included placement of a salivary bypass tube and a possible consequence of gastric pull-up surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Of the 33 summarized cases, thirteen cases survived all episodes of bleeding (39%). 21,22,24,27,28,30,31,33,34,[36][37][38]43 The severity of bleeding, in the setting of several comorbid conditions, likely contributed to the high mortality rate.…”

Section: Discussionmentioning

confidence: 99%

Upper Gastrointestinal Bleeding From Aberrant Right Subclavian Artery-Esophageal Fistula

Peress

Tuqan

Thomas

2021

TOJ

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Background:The most common aortic arch abnormality is an aberrant right subclavian artery (ARSA). ARSA-esophageal fistula is a rare sequela that can present with a life-threatening upper gastrointestinal (GI) bleed. Case Report: We report the case of an 88-year-old male who presented with signs of upper GI bleeding. Esophagogastroduodenoscopy demonstrated extrinsic compression of the upper third of the esophagus with ulceration. Imaging studies revealed ARSA posterior to the esophagus with pseudoaneurysm formation. These findings confirmed an upper GI bleed secondary to ARSA-esophageal fistula. The patient underwent prompt embolization of the ARSA pseudoaneurysm, followed a few days later by coil embolization of the ARSA pseudoaneurysm. Despite these interventions, the patient continued to have bleeding with anemia. He and his family opted to avoid any further interventions and instead pursued comfort care. The patient was discharged to hospice and died 3 months later. Conclusion: ARSA-esophageal fistula is a rare but potentially lethal cause of upper GI bleeding. Initial signs and symptoms can be subtle, but the presence of a GI bleed requires immediate stabilization. Surgical interventions have been shown to have longerlasting success, but endovascular repair may be an option for patients who are deemed unfit for surgery but still require prompt stabilization. Regardless of the intervention, mortality rates for ARSA-esophageal fistula are high.

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Aberrant Right Subclavian Arterioesophageal Fistula: Endovascular Occlusion via a Transbrachial Approach

Cited by 9 publications

References 4 publications

Upper Gastrointestinal Bleeding Secondary to an Aberrant Right Subclavian Artery-Esophageal Fistula: A Case Report and Review of the Literature

Upper Gastrointestinal Bleeding Secondary to an Aberrant Right Subclavian Artery-Esophageal Fistula: A Case Report and Review of the Literature

Treatment of Symptomatic Aberrant Subclavian Arteries

Upper Gastrointestinal Bleeding From Aberrant Right Subclavian Artery-Esophageal Fistula

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