Aortoesophageal Fistula after Thoracic Endovascular Aortic Repair Diagnosed and Followed with Endoscopy

Chiba, Daisuke; Hanabata, Norihiro; Araki, Yasumitsu; Sawaya, Manabu; Yoshimura, Teizo; Aoki, Masahiko; Shimoyama, Tadashi; Fukuda, Shinsaku

doi:10.2169/internalmedicine.52.9139

Cited by 19 publications

(21 citation statements)

References 5 publications

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“…The most common EGD finding of AEF is a sub-mucosal tumor-like protrusion with/without clots/debris due to extrinsic compression on the esophageal wall. Other reported EGD findings included ulcerative lesions, oozing from a pin-hole erosion or a pulsating protrusion with fistula, which might be related to graft exposure [35,49,50]. Interestingly, AEF is usually observed between the posterior to left lateral wall of the upper/middle-esophagus in the endoscopic findings.…”

Section: Importance Of Early Diagnosis Of Post-tevar Aefmentioning

confidence: 96%

“…Chiari's triad of mid-thoracic pain and sentinel hematemesis followed by massive hematemesis was reported as the representative symptom of AEF [31][32][33][34][35][36]. In an original study of 500 AEF cases, Hollander and Quick mentioned that hematemesis, chest pain or dysphagia were observed in 63, 58 and 42% of the subjects, respectively [2].…”

Section: Symptom Of Post-tevar Aefmentioning

confidence: 99%

“…While most cases seem to occur within 1-16 months after the TEVAR procedure, Kouritas et al reported one case of AEF that developed 6 years after TEVAR [38]. Other less frequent presentations of post-TEVAR AEF were dysphagia due to extra-luminal compression of the esophageal wall or highgrade fever due to mediastinitis, infection of the surgical/ endovascular graft or sepsis [22,34,35]. A recent review revealed that hematemesis, hypovolemic shock or systemic infection were observed in 86.1, 60.9 or 21.7% of 72 patients with post-TEVAR AEFs, respectively [28].…”

Section: Symptom Of Post-tevar Aefmentioning

confidence: 99%

“…Miller et al reported that the sensitivity of even conventional endoscopy was only 38% [52]. Furthermore, Chiba et al suggested that the intubation of a trans-nasal small caliber endoscopy might be safer than a trans-oral conventional endoscopy for AEF patients in poor condition in an urgent situation, but the sensitivity of the former is much lower than that of the latter [35,53].…”

Section: Importance Of Early Diagnosis Of Post-tevar Aefmentioning

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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Section: Importance Of Early Diagnosis Of Post-tevar Aefmentioning

confidence: 96%

Section: Symptom Of Post-tevar Aefmentioning

confidence: 99%

Section: Symptom Of Post-tevar Aefmentioning

confidence: 99%

Section: Importance Of Early Diagnosis Of Post-tevar Aefmentioning

confidence: 99%

See 2 more Smart Citations

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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show abstract

“…With hyoid, larynx and pharynx affected most commonly, signs of incomplete tilting of the epiglottis, pharyngeal weakness and postdeglutitive aspiration can be found [79]. Postoperative dysphagia was reported following vascular ring division [9], type I thoracoabdominal aneurysm repair [33], arterial switch with the Lecompte maneuver [71], coil embolisation of an aortopulmonary collateral artery [8], and thoracic endovascular aortic repair [22]. Acute dysphagic syndrome after thoracic aorta endografting has been anecdotically reported, and its aetiology remains undefined [54].…”

Section: Postoperative Dysphagiamentioning

confidence: 99%