In situ aortic allograft insertion to repair a primary aortoesophageal fistula due to thoracic aortic aneurysm

Abstract

Aortoesophageal fistula due to thoracic aortic aneurysm is an uncommon cause of gastrointestinal bleeding and has an extremely poor prognosis. In the English literature, we found only 27 successfully managed cases of primary aortoesophageal fistula due to thoracic aortic aneurysm. We present a case of 74-year-old man who experienced the erosion of a thoracoabdominal aortic aneurysm into the esophagus. We successfully performed resection and replacement of the thoracoabdominal aorta with a cryopreserved allograft and total thoracic esophagectomy. A few months later, the esophagus was reconstructed with orthotopic colonic interposition. The patient recovered well and resumed a normal life (12 months' follow-up).

A multidisciplinary approach to aortoesophageal fistula: a case report

“…From our experience, we agree with others that conservative management is of no help especially in non-compliant patients like ours. [8,9] In our patient, esophageal exclusion and debridement were considered the best management followed by restoration of esophageal continuity with gastric pull-up. We used a pectoral myocutaneous flap for secondary esophageal reconstruction when anastomotic dehiscence at the upper anastomosis of the gastric pull-up had occurred.…”

“…[2] Thoracic CT is the most important tool in diagnosis and planning for management. [8] Management should not be delayed once AOF is diagnosed. Management consists of two essential parts.…”

“…[7][8] Different methods of aortic repair are mentioned in the literature, including direct aortic suture, patch angioplasty, in-situ graft replacement, and recently percutaneous endovascular stent grafting. [3,5,8] Our patient was high-risk with multiple co-morbidities so we preferred a rapid and less invasive technique to control bleeding and repair the aortic aneurysm. We used percutaneous endovascular stent grafting to manage the aortic aneurysm and tried to manage the esophageal defect conservatively due to the bad general condition of the patient.…”

Definitive Treatment for Aortoesophageal Fistula by Endovascular Stent Graft

“…Some surgeons, such as Burks, Pirard, Topel, and others [5][6][7], consider repairing aortic defect of AEF by endovascular stent should be seemed as a transitional measure before definitive open surgery. Or even, Prokakis et al suppose that endovascular stent grafting should be limited only to patients who are at high risk for open surgical repair [8].…”

Aortoesophageal fstula: A case misdiagnosed as esophagealpolyp

“…Therefore, some authors suggested that an endovascular stent graft should only be used in patients with a high risk of open surgery [2,6] . Since 2005, Pirard et al [7,8] have attempted to combine endovascular with open surgical approach, which brings more hope to decrease the mortality of AEF.…”