Management of secondary aortoesophageal fistula without graft extraction

Abstract

Aortoesophageal fistula is a rare but fatal complication of thoracic aortic surgery. The prognosis for the subtype of esophagoparaprosthetic fistula (EPPF), in which the implanted aortic prosthesis protrudes into the esophageal lumen, is especially poor. Here we report a case of EPPF that was successfully managed without removal of the aortic prosthesis.

Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection

“…Some cases of AEF occur as complications after the surgical prosthetic repair of an aneurysm or thoracic endovascular aortic repair (TEVAR) [ 1 – 4 ]. AEF is classified as primary (communication between the untreated diseased thoracic aorta and the adjacent esophagus) or secondary (communication between the repaired aorta and the esophagus) [ 2 , 3 , 5 ]. The incidence of secondary AEF after surgery is relatively low (4.8%).…”

“…Secondary AEF between the interposed prosthetic aortic graft and the adjacent esophagus is defined as EPPF. Typically, patients with EPPF display sepsis and massive hematemesis, with an extremely poor prognosis if untreated [ 3 , 5 , 6 ].…”

“…Orthotopic in situ aortic reconstruction should be performed, although EAB grafting may be an alternative to reconstruction with the prosthesis in situ. Several options are available for aortic replacement, including the implantation of a prosthetic graft with or without antibiotic treatment, cryopreserved aortic allografts, or a bovine pericardial roll [ 1 – 3 , 5 – 8 ]. Esophageal defects can be treated surgically in two ways: primary repair of the esophagus or esophageal exclusion followed by delayed reconstruction.…”

“…Radical debridement is essential. Omentopexy is another option for the surgical treatment of AEF, possibly preventing infective complications because of the high resistance to infection resulting from high vascularity and neo-vascularization potential [ 1 – 3 , 5 , 6 ]. Another important point is antibiotic therapy.…”

One-stage radical operation of aortoesophageal fistula -combination of VATS esophagectomy and open aortic surgery: report of a case

“…We had also recently undertaken a onestage operation of an AEF caused by previous aortic graft placement by performing VATS esophagectomy and simultaneous reconstruction by gastric conduit [3].…”