Aortobronchial and aortoesophageal fistulae as risk factors in surgery of descending thoracic aortic aneurysms

Segesser, Ludwig K. von; Tkebuchava, Tengis; Niederhäuser, U; KUNZLI, A; Lachat, Mario; Genoni, Michele; Vogt, Paul; Jenni, Rolf; Turina, Marko

doi:10.1016/s1010-7940(97)00142-5

Cited by 50 publications

(32 citation statements)

References 17 publications

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“…Hemoptysis cases have been reported after the aort coarctation repairment operations as a result of the postoperative ABFs (5,10,11). As observed in the previous cases, aneurysm formation most often occurred in patients who had undergone synthetic patch aortoplasty (11,12).…”

mentioning

confidence: 73%

Massive hemoptysis, the etiology is aorto-bronchial fistula

Uçan¹,

Goktay²,

Uluorman³

et al. 2012

Tuberk Toraks

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A 41-year-old man presented with massive hemoptysis. On physical examination, auscultation of the lung reveals inspiratory crackles, predominantly located in the lower posterior lung zones and auscultation of the heart reveals 2/6 systolic souffle in all of the cardiac zones. During the observation in emergency room, the patient's hemoglobin values decreased from 15.5 mg/dL to 11.7 mg/dL. Because of this reason, erytrocyte suspension transfusion had been processed. Bilateral diffuse infiltration could be seen in postero-anterior chest X-ray. In the computed tomography (CT) of thorax, there was bilateral parenchymal ground glass opacities and consolidations (Figure 1). During bronchoscopy, active bleeding from bilateral bronchial system was observed. Since intraalveolar hemorrhage was considered at the patient, etiology oriented examinations were evaluated. Patient was extubated after the hemopthysis had been controlled and then, he was transferred to the chest diseases clinique from the intensive care unit. Both in bronchoscopic samples and sputum samples of the patient, there was no acid resistant bacterium in direct microbiological examination and cultures for acid resistant bacterium were negative. In the evaluation of the patient in terms of vasculitic syndromes; anti-nuclear antibody, anti-neutrophilic cytoplasmic antibody and ENA panel were detected and they were all negative. In the medical consultation made with cardiothoracic surgery, there was no additional suggestion. In the control bronchoscopy for hemorrhage, only a former bleeding focal point on the left main bronchi has been observed. During bronchoscopy; bronchial lavage, bronchoalveolar lavage (from the right middle lobe bronchi) and transbronchial biopsy samples were obtained. However, those samples weren't useful for a specific diagnosis. Three months later, in the control CT of thorax of the case, ground glass 295Massive hemoptysis, the etiology is aorto-bronchial fistula

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mentioning

confidence: 73%

Massive hemoptysis, the etiology is aorto-bronchial fistula

Uçan¹,

Goktay²,

Uluorman³

et al. 2012

Tuberk Toraks

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“…The current surgical approach, such as (i) primary resection of the esophagus, (ii) debridement of the contaminated tissues followed by abundant lavage of the mediastinum and (iii) in situ reconstruction of the aorta with a prosthesis, has been established as the first-line surgical strategy for AEF [25,[56][57][58][59]. Fig.…”

Section: Radical Surgical Approachmentioning

confidence: 99%

“…However, primary repair is reported to be frequently unsuccessful, due to the weakness of the wound and refractory defects of AEF, and, as a result, the breakdown from suturing defects might induce the recurrence of AEF [56]. Instead of wall repair, esophageal resection might eliminate the risk from disruption of the sutured fistula and minimize the recurrence of contamination through the fistula (Fig.…”

Section: Radical Surgical Approachmentioning

confidence: 99%

“…3). Therefore, most recent studies emphasized the importance of sub-total esophagectomy and ligation of the distal esophagus with a cervical esophagostomy and concomitant gastrostomy or jejunostomy to enable enteral access to bypass the fistula [25,56]. However, such management has a significant mortality of from 25 to 78% due to its massive invasiveness in patients in a physiologically poor condition [21,34,[60][61][62].…”

Section: Radical Surgical Approachmentioning

confidence: 99%

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Management of aorto-esophageal fistula secondary after thoracic endovascular aortic repair: a review of literature

Uno

Koike

Takahashi

et al. 2017

Clin J Gastroenterol

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Aorto-esophageal fistula (AEF) is a rare and lethal entity, and the difficulty of making diagnosis of AEF is well-known. As promising results in the short-term effectiveness of thoracic endovascular aortic repair (TEVAR) promote its usage, the occurrence of AEF after TEVAR (post-TEVAR AEF) increases as one of the major complications. Therefore, we provide a review concerning the management strategy of post-TEVAR AEF. Although its representative symptom was reported as the triad of mid-thoracic pain and sentinel hematemesis followed by massive hematemesis, the symptom-free interval between sentinel hemorrhage and massive exsanguination is unpredictable. However, the physiological condition represents a surgical contraindication. Accordingly, early diagnosis is important, but either CT or esophago-gastroduodenoscopy rarely depicts a typical image. The formation of post-TEVAR AEF might be associated with the infection of micro-organisms, which is uncontrollable with anti-biotic administration. The current first-line strategy is combination therapy as follows, (1) to control bleeding by TEVAR in the urgent phase, and (2) radical debridement and aortic/esophageal re-construction in the semi-urgent phase. In view of the high mortality and morbidity rate, it is proposed that the choice in treatment strategies might be affected by patient's condition, size of the wall defects and the etiology of AEF. Practically, we should keep in mind the importance of making an early diagnosis and, once a suspicious symptom has occurred in a patient with a history of TEVAR, the existence of post-TEVAR AEF should be suspected. A prospective registry together with more developed technologies will be needed to establish a future strategy.Keywords Aorto-esophageal fistula Á Thoracic endovascular aortic repair Á Thoracic aortic aneurysm Á Endoscopy Á Surgery Abbreviations

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“…Im Vergleich zu aortobronchialen Fisteln zeigen aortoösophageale Fisteln eine hö here Morbidität und Mortalität [30]. Ei ne deutlich schlechtere Prognose zeigt sich zudem bei kombinierter bronchi aler und ösophagealer Fistel oder isolier ter ösophagealer Fistel mit einer Letalität bis 100% im ersten Jahr [30].…”

Section: Aortoösophageale Fistelnunclassified

Endovaskuläre Aortenchirurgie

Hyhlik‐Dürr

Geisbüsch

Hakimi

et al. 2009

Chirurg

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Secondary aortobronchial or aorto-enteral fistulas have an incidence of 0.36-4% and are a rare but life-threatening complication after endovascular aorta reconstruction. Due to the rarity of the disease and the heterogeneity of the patients (age, risk profile, localization) individual-specific solutions are necessary. The primary symptomatic, differential diagnosis and individual therapy concepts will be presented and discussed based of five case reports (2 aorto-esophageal fistulas, 2 aortobronchial fistulas and 1 aorto-duodenal fistula).

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Aortobronchial and aortoesophageal fistulae as risk factors in surgery of descending thoracic aortic aneurysms

Abstract: Outcome of patients suffering from descending thoracic aortic aneurysms complicated by aorto-bronchial fistulae can be similar to that without fistulae, whereas for cases complicated by aorto-esophageal fistulae the prognosis seems to remain poor even after successful hospital discharge.

Cited by 50 publications

References 17 publications

Massive hemoptysis, the etiology is aorto-bronchial fistula

Massive hemoptysis, the etiology is aorto-bronchial fistula

Management of aorto-esophageal fistula secondary after thoracic endovascular aortic repair: a review of literature

Endovaskuläre Aortenchirurgie

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