Secondary aorto-esophageal fistula after esophagectomy treated with endovascular treatment

Abstract

Rationale: Aorto-esophageal fistula (AEF), a postoperative complication of esophagectomy, constitutes a very small percentage of all cases presenting with AEF; however, it is associated with a high mortality rate. Acute massive hemorrhage is the single largest cause of death in patients developing AEF. There is a lack of consensus on the optimal treatment of AEF.Patient concerns: We present 3 cases secondary to esophagectomy due to lower thoracic esophageal carcinoma. All 3 patients presented with similar acute symptoms including a critical and life-threatening course with dead feeling, thoracic pain, and projectile hematemesis, and also hypovolemic shock.Diagnoses: Digital subtraction angiography identified AEF as the diagnosis of these 3 cases.Interventions: All patients were treated with emergency thoracic endovascular aortic repair, the aortic fistulas were repaired.Outcomes: All patients successfully survived the perioperative period.Lessons: Thoracic endovascular aortic repair, a minimally invasive technique, is a better method to achieve faster and safer hemodynamic stability in patients with AEF compared with open thoracic aortic repair.Abbreviations: AEF = aorto-esophageal fistula, DSA = digital subtraction angiography, TEVAR = thoracic endovascular aortic repair.

Prolonged survival of a patient with aortogastric fistula treated with combined surgery and endovascular stent placement: A case report

“…The present patient was previously reported in 1999 as the first patient surviving surgery for aortogastric tube fistula. Since then, only one of the six reported patients with aortogastric tube fistula due to anastomotic leakage have survived for two years [ 1 , 3 , 5 , 6 ]. The 30-day survival was achieved in four of the patients.…”

Comparison of Ivor-Lewis versus Sweet procedure for middle and lower thoracic esophageal squamous cell carcinoma

“…It has been proposed that thoracic endovascular aortic repair may be a method for treating aortoesophageal fistula. [16] Tracheoesophageal fistula is also associated with severe complications and increased mortality. [17] This condition leads to the settlement of digestive juices into the lungs, causing severe lung infections.…”

The role of TEVAR in the management of a recurrent aorto-gastric fistula

“…In this case the pathology was a gastric ulcer. There are case reports of patients who had AEF early after Sweet’s oesophagectomy [ 5 ] but there is no mention in the literature of such a late presentation, 15 years later post oesophagectomy.…”

“…The use of endo-vascular strategies to treat a fistula was first report by Chuter et al [ 6 ], who used a stent graft to exclude an aorto-bronchial fistula . Even though there are no guidelines to address the use of TEVAR in the management of AEFs its use in other aortic pathologies such as aortic dissections and aneurysms, and the benefits of low morbidity and mortality associated with these procedures favour its use when available to rapidly salvage a patient exsanguinating due to an aorto-oesophageal fistula [ 5 ]. The benefits of TEVAR as a first-choice procedure in these cases are; the avoidance of a thoracotomy, aortic cross-clamp and cardio-pulmonary bypass and their associated complications, especially in a haemodynamically compromised patient.…”