Strategies for the treatment of aorto-oesophageal fistula†

Abstract

Bridging TEVAR is a useful adjunct in treating AEF patients with shock. One-stage surgery consisting of resection of the aneurysm and oesophagus, in situ reconstruction of the descending aorta and omental flap installation provided a better outcome in the AEF surgical strategy compared with conservative treatment.

Aorto‐esophageal fistula: the multi‐disciplinary team approach to management

“…3) 1, 2. Although there is no specific guidance on the use of endovascular intervention for aorto‐esophageal fistula, the European Society of Cardiology (ESC) recommends TEVAR for complex type B dissection and comparable conditions 3.…”

Definitive Treatment for Aortoesophageal Fistula by Endovascular Stent Graft

“…Since 1994, when endovascular treatment was firstly reported to manage aortic lesion of AEF [4], treatment of AEF has become easier than before. 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.…”

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

“…There is no consensus regarding the optimal aortic substitute, including the implantation of a Dacron graft, a PTFE graft and so on [68]. In other words, TEVAR itself does nothing to control the infectious condition or to heal the esophageal wall defect, leaving the patients at risk of graft infection and/or fistula recurrence and persistent mediastinitis.…”

“…A previous meta-analysis study described that the recurrence of AEF and graft infection after TEVAR occurred in 13.8 and 15.2% of the patients, respectively [28], and that prolonged ineffective administration of intra-venous anti-biotic medicine was the most significant factor associated with a lower mortality in the multi-variate analyses, despite the lack of definitive strategies for post-operative anti-biotic usage. Previous studies pointed out that the outcome of conservative management alone after TEVAR might be fatal due to recurrent hemorrhage or sepsis [26,28,40,[68][69][70][71][72]. Accordingly, TEVAR should be performed only as a bridging treatment before radical surgery is planned to treat the inflamed lesions of AEF patients [69].…”

“…Despite the lack of consensus about the appropriate interval from TEVAR to radical surgery, Okita et al proposed that the optimal timing was within 1 week; otherwise, the graft infection might progress [68].…”