Thoracic endovascular aortic repair in management of aortoesophageal fistulas

Abstract

Late infection or recurrence of the AEF and associated mortality rates are high when TEVAR is used as a sole therapeutic strategy. Prolonged antibiotic treatment has a strong negative association with mortality. A strategy of a temporizing endovascular procedure to stabilize the patient in extremis, and upon recovery, an open surgical esophageal repair with or without stent graft explantation is advocated.

Thoracic Endovascular Aortic Repair for Aortoesophageal Fistula After Covered Rupture of Aortic Homograft – A Durable Option?

“…Most commonly parenteral antibiotics are given for 2 to 8 weeks post-procedure, but whether lifelong oral antibiotics are necessary is debatable [6]. Most recently, Canaud et al reviewed the outcomes of TEVAR for AEF and reported that prolonged antibiotic treatment (i.e., greater than 4 weeks) was associated with significantly lower aortic mortality [7].…”

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

“…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].…”

“…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].…”

“…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]. As the clinical use of TEVAR has been widespread, a recent metaanalysis study demonstrated that primary malignant/benign esophageal disease, a prior treatment of open surgery or TEVAR of TAA, untreated TAA or a foreign body might be associated with the AEF formation in 23.6, 20.8, 20.8 or 12.5% of 72 AEF patients with the initial treatment of TEVAR, respectively [28]. Therefore, in the near future, the incidence of post-TEVAR AEF as one of the major complications of TEVAR may increase further by the widespread use of TEVAR for TAA, AEF and post-TEVAR AEF.…”

“…Other less frequent presentations of post-TEVAR AEF were dysphagia due to extra-luminal compression of the esophageal wall or highgrade fever due to mediastinitis, infection of the surgical/ endovascular graft or sepsis [22,34,35]. A recent review revealed that hematemesis, hypovolemic shock or systemic infection were observed in 86.1, 60.9 or 21.7% of 72 patients with post-TEVAR AEFs, respectively [28].…”