Delayed presentation of aortoesophageal fistula after endovascular repair

Kouritas, Vasileios; Dedeilias, Panagiotis; Sotiriou, Konstantina; Klimopoulos, Serafim

doi:10.1177/0218492314538035

Cited by 3 publications

(2 citation statements)

References 6 publications

(18 reference statements)

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“…Different mechanisms of AEF development following TEVAR have been postulated including direct erosion of the stent graft into the esophagus, pressure necrosis of the self-expanding prosthesis, ischemic necrosis of the esophagus due to interruption of its vasculature, infection of the stent graft, and the presence of an endoleak [5, 6]. AEF usually occurs within few months after TEVAR, but Kouritas et al [7] reported one case of AEF that developed 6 years after TEVAR.…”

Section: Discussionmentioning

confidence: 99%

Atypical Aortoesophageal Fistula with Atypical and Delayed Presentation and Negative Imaging Studies

Hakim

Gjeorgjievski

Garg

et al. 2016

Case Reports in Gastrointestinal Medicine

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A 59-year-old man with past medical history of thoracic aortic aneurysm treated with thoracic endovascular aortic repair presented with melena for 2 weeks. Initial EGD did not reveal the source of bleeding and showed normal esophagus; abdominal arteriogram did not reveal a fistulous communication and initial CTA showed normal position of the aortic graft stent without endoleak. The sixth EGD revealed a submucosal tumor-like projection in the upper esophagus and stigmata of recent bleeding. Another thoracic endovascular aortic repair with stent was placed over the old graft for presumed aortoesophageal fistula. Poststent upper gastrointestinal series with contrast showed extravasation of the contrast from the esophagus and CTA showed fistulous tract between aorta and esophagus. The patient refused definitive surgical repair despite having infected aortic graft; jejunostomy tube was placed and life-long suppressive antibiotic treatment was given and the patient is doing well at 2-year follow-up.

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Section: Discussionmentioning

confidence: 99%

Atypical Aortoesophageal Fistula with Atypical and Delayed Presentation and Negative Imaging Studies

Hakim

Gjeorgjievski

Garg

et al. 2016

Case Reports in Gastrointestinal Medicine

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“…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].…”

Section: Symptom Of Post-tevar Aefmentioning

confidence: 99%

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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