Aortic prosthetic graft infection accompanied with esophagomediastinal fistulas: A case report

Abstract

Prosthetic graft infection is difficult to diagnose early, and hence, is associated with high mortality and morbidity rates. A 63-year-old man who had undergone surgical prosthetic replacement for an inflammatory thoracic aortic aneurysm 10 months previously visited our emergency room, complaining of chills, shivering, frequent vomiting, and back pain. He was diagnosed with severe sepsis, and a blood culture detected Streptococcus anginosus and Prevotella oralis. Repeated contrast-enhanced computed tomography (CT) scans of his chest revealed ectopic gas around the graft, and esophagogastroduodenoscopy revealed esophageal perforations at several sites. We therefore diagnosed him with aortic prosthetic graft infection accompanied with esophagomediastinal fistulas. He received medical treatment and three operations and recovered from the infection. This is a rare case of aortic prosthetic graft infection accompanied with esophagomediastinal fistulas, and we conclude that repeated CT is useful for identifying the primary infection site and invasion route in patients with suspected aortic prosthetic graft infection.

Perigraft Abscess Subsequent to Aortoesophageal Fistula

“…Repetitive mechanical damage due to arterial pulsation, esophageal wall circulation interruption by an enlarged aneurysm, and persistent vascular prosthesis infection are believed to cause AEF ( 6 ). A previous report described a case diagnosed with aortic prosthetic graft infection accompanied by aorto-enteric fistula after vascular surgery ( 7 ); however, in the present case, the thoracic aortic aneurysm had gradually increased in size because of a perigraft endoleak after aortic reconstruction without any sign of infection. Of note, it is extremely interesting that the patient's conditions started to worsen and he developed sepsis after the upper endoscope examination.…”

Surgical treatment for secondary aortoesophageal fistula after prosthetic aortic replacement: A report of four cases

“…Some papers suggested that combined surgery provided better outcomes for some patients of secondary AEF [ [7] , [8] , [9] ] ( Table 2 ). What they suggested in common is that the first treatment of secondary AEF is infection control, with esophagectomy being the first stage.…”

“… Year Author [Reference] Number of cases Surgery of fistula Outocomes 2012 A. Saito et al [ 4 ] Six cases (four after TEVAR and two after open graft replacement) Five cases received staged surgery and one received simultaneous it. Two in-hospital deaths (one case of staged surgery and one of simultaneous it) 2012 M. Amano et al [ 7 ] One case after TAR Three staged surgery (first: esophagectomy and esophagostomy, second: re-replacement, Third: esophageal reconstruction) Discharge 2013 H. Munakata et al [ 8 ] One case after TEVAR Two staged surgery (First: aortic replacement, esophagectomy and esophagostomy, Second: retrosternal gastric bypass) Discharge 2019 A. Kamigaichi et al [ 9 ] One case after TEVAR Three staged surgery (first: esophagectomy and esophagostomy, second: aortic replacement, Third: esophageal reconstruction) Discharge …”

“…With the increase of thoracic aortic aneurysm surgery and thoracic endovascular aortic repair (TEVAR), secondary AEF has been reported [ [1] , [2] , [3] ]. Some treatment strategies for AEF have been presented [ [4] , [5] , [6] , [7] , [8] , [9] ]. However, there have been few reports with multiple cases of secondary AEF after prosthetic aortic replacement, so the treatment strategies remain controversial.…”