Therapeutic strategy for treating aortoesophageal fistulas

Akashi, Hidetoshi; Kawamoto, Shunsuke; Saiki, Yoshikatsu; Sakamoto, Tomohiko; Sawa, Yoshiki; Tsukube, Takuro; Kubota, Suguru; Matsui, Yoshiro; Karube, Norihisa; Imoto, Kiyotaka; Yamanaka, Katsuhiro; Kondo, Shunichi; Tobinaga, Satoru; Tanaka, Hiroyuki; Okita, Yutaka; Fujita, Hiromasa

doi:10.1007/s11748-014-0452-4

Cited by 74 publications

(72 citation statements)

References 24 publications

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“…[5,6] Late infection and associated mortality rates are higher when TEVAR is used as the sole therapeutic strategy. [7] Thus, a staged approach for AEF treatment has been proposed in recent years.…”

Section: Discussionmentioning

confidence: 99%

Secondary aorto-esophageal fistula after esophagectomy treated with endovascular treatment

Ren

He²,

Wang³

et al. 2017

Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

Secondary aorto-esophageal fistula after esophagectomy treated with endovascular treatment

Ren

He²,

Wang³

et al. 2017

Medicine

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“…Several complications of TEVAR, including paraplegia, stroke, post-implantation embolisms and AEF, have been reported [21][22][23][24][25][26][27][28][29][30]. The incidence of post-TEVAR AEF was reported to be 1.7-1.9%, comparable to the incidence after open surgery for TAA, resulting in a high rate of re-stenting for AEF recurrence [21][22][23].…”

Section: Etiologies Of Aorto-esophageal Fistulamentioning

confidence: 99%

“…Actually, the high rate of mortality and morbidity of this surgical approach might be associated with the nature of emergency surgery to access the damaged aorta in a contaminated field, as well as the need for an invasive procedure, such as thoracic aortic crossclamping or cardio-pulmonary bypass (CPB). In a recent study of 47 AEF patients, the newly established surgical strategies-esophagectomy, in situ reconstruction of the aorta, and additional wrapping of the fistula with a flapwere reported to be effective in the improvement of the mid-term mortality rate after the surgery [26]. Further development of surgical strategies will be needed.…”

Section: Radical Surgical Approachmentioning

confidence: 99%

“…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].…”

Section: Controlling Fatal Bleeding From Aefmentioning

confidence: 99%

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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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“…Short- and long-term fatality rates in adult AEF have been reported at 46.8% and 70.3%, respectively. 12 There have been a few reported cases of survival in children after AEF from other causes, 13,14 but only one after AEF associated with BBI. 15 These reports, however, stress the importance of prompt recognition and intervention to maximize the potential for patient survival after BBI.…”

Section: Introductionmentioning

confidence: 99%

Button Battery Ingestion in Children

Leinwand

Brumbaugh

Krämer

2016

Gastrointestinal Endoscopy Clinics of North America

131

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SUMMARY Although the existence of national data on BBIs provides much-needed information on the epidemiology of these serious injuries, there are no prospective studies available to guide management decisions. As a result, treatment recommendations are primarily based on expert opinion from related clinical experience. The single-center experience of the serious esophageal BBI cases presented in this article is the largest published outside of the compiled national data and offers important lessons for the management of future cases. Additional study is needed to better define the role of acid blockade, endoscopy, and MRI in the postremoval management of these cases and determine optimal timing for initiation of enteral feeding. Advocacy efforts are ongoing and vital in order to minimize the occurrence of these potentially fatal injuries.

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Therapeutic strategy for treating aortoesophageal fistulas

Abstract: The use of thoracic endovascular aortic repair alone for AEF should not be considered a definitive surgery. In contrast, esophagectomy, open surgery with aortic replacement using prostheses and homografts and greater omentum wrapping significantly improve the mid-term survival of AEF.

Cited by 74 publications

References 24 publications

Secondary aorto-esophageal fistula after esophagectomy treated with endovascular treatment

Secondary aorto-esophageal fistula after esophagectomy treated with endovascular treatment

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

Button Battery Ingestion in Children

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