Secondary Aortoesophageal Fistula Associated With Aneurysmal Graft Infection by Coxiella burnetii

Okwara, Chinemerem; Petrášek, Jan; Gibson, Maeghan; Burstein, Ezra

doi:10.14309/crj.2016.39

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…In their review article, Canaud et al [26]showed that, in >40% of the patients with post-TEVAR AEF, micro-organisms were detected, and in patients with virulent inflammation, pathogens could be isolated. Another study also detected a virulent pathogen, Coxiella burnetti , in aneurysmal graft infection [27].…”

Section: Discussionmentioning

confidence: 99%

A Single-Center Case Series of Endoscopically Treated Aorto-Gastrointestinal Fistula after Endovascular Aortic Repair: Surgery Is Still the Only Valid Solution

et al. 2020

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Introduction: Aortoesophageal fistula (AEF) is a life-threatening complication associated with endovascular aortic repair (EVAR) and occurs mostly in patients who undergo thoracic EVAR (TEVAR). To date, surgical treatment of AEF has been considered the most promising therapeutic approach. New endoscopic techniques could contribute to the therapy of AEF. The aim of this study was to analyze the outcome after endoscopic treatment of EVAR-associated AEF. Methods: All patients who received endoscopic diagnostics and/or therapy for AEF after EVAR/TEVAR in our center between 2010 and 2019 were evaluated. Results: Seven suitable patients were included. Six of them had undergone TEVAR and 1 had EVAR. Fistula occurred at an average of 307 days (range 21–2,774 days) post-EVAR. Endoscopic treatment was performed on 4 patients by using an over-the-scope clip (OTSC®). However, fistula recurred in all patients who were initially treated endoscopically. They were then treated either by sequential application of further OTSCs® or by implantation of a fully coated, self-expanding metal stent. One of these patients underwent a partial esophageal resection in a subsequent treatment approach. All patients died during the observational period, 5 as a direct consequence of the AEF/aortoduodenal fistula and 2 due to comorbidities. The median survival time after fistula occurrence was 120 days (range 5–823 days). Conclusion: Endoscopic treatment of AEF with OTSC® should be considered as a possible interim solution, especially in patients with severe comorbidities. However, surgical remediation still appears to be the only procedure with intermediate to long-term therapeutic success.

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Section: Discussionmentioning

confidence: 99%

A Single-Center Case Series of Endoscopically Treated Aorto-Gastrointestinal Fistula after Endovascular Aortic Repair: Surgery Is Still the Only Valid Solution

et al. 2020

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“…Парааортальный абсцесс был четко верифицирован только при МСКТ. Этот метод считают обязательным у пациентов с синтетическим протезом при появлении необъяснимого повышения температуры [9,11,12,18,30,31].…”

Section: Discussionunclassified

“…Удаление аортального эндопротеза чаще всего проводят через заднебоковую левостороннюю торакотомию [24,29]. Этим же доступом некоторые хирурги восстанавливают непрерывность аорты, считая возможным имплантацию в инфицированную зону протезов, обработанных рифампицином, или криосохраненных гомографтов [9,14,18,27,29,31]. В представленном случае высокая проксимальная локализация стент-графта делала проблематичным его удаление этим путем.…”

Section: клинические наблюдения §unclassified

The Case of Successful Surgical Treatment of a Patient With Thoracic Endograft Infection in 5 Years After Thoracic Endovascular Aortic Repair

Попов

Коростелев

Malishenko

et al. 2018

CARDIO

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“…Actually, the incidence of infection around the graft expanding to the esophagus was reported to be 0.5-5%, and has been proposed as having a central role in the development of post-TEVAR AEF [22]. In a review article, micro-organisms were reported in 43.2% of the patients after TEVAR for AEF, and, in 31.2% of the patients with inflammation, highly virulent pathogens, such as methicillin-resistant Staphylococcus aureus, Streptococcus spp., Gram-negative species, such as Pseudomonas and Klebsiella, or Coxiella burnetti were isolated [28,41]. These findings suggest that micro-organisms associated with the post-TEVAR AEF formation could hardly be controlled with general use of antibiotic therapy [32].…”

Section: Mechanism Of Post-tevar Aefmentioning

confidence: 98%

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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Secondary Aortoesophageal Fistula Associated With Aneurysmal Graft Infection by Coxiella burnetii

Abstract: Aortoesophageal fistula is a rare and serious condition that carries a high mortality rate. We present a case of overt gastrointestinal bleeding from an aortoesophageal fistula in a patient with chronic infection of an endovascular prosthesis with Coxiella burnetii.

Cited by 4 publications

References 7 publications

A Single-Center Case Series of Endoscopically Treated Aorto-Gastrointestinal Fistula after Endovascular Aortic Repair: Surgery Is Still the Only Valid Solution

A Single-Center Case Series of Endoscopically Treated Aorto-Gastrointestinal Fistula after Endovascular Aortic Repair: Surgery Is Still the Only Valid Solution

The Case of Successful Surgical Treatment of a Patient With Thoracic Endograft Infection in 5 Years After Thoracic Endovascular Aortic Repair

Management of aorto-esophageal fistula secondary after thoracic endovascular aortic repair: a review of literature

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