Thoracic Endovascular Aortic Repair of Esophageal Cancer-Associated Aortoesophageal Fistula: A Case Report and Literature Review

Sasaki, Akira; Egashira, Hideto; Tokoro, Shinnosuke; Ichita, Chikamasa; Takizawa, Satoshi; Tsukiyama, Toshitaka; Ogino, Hitoshi; Kawachi, Jun; Shimoyama, Rai; Kako, Makoto

doi:10.1155/2018/9851397

Cited by 13 publications

(16 citation statements)

References 9 publications

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“…TEVAR can prevent sudden death and gain time for surgical treatment, radiotherapy and chemotherapy[ 17 , 18 ]. To date, TEVAR is the only option for AEF caused by unresectable esophageal cancer[ 19 ]. Compared to surgery, TEVAR has many advantages for the treatment of AEF, such as a good hemostatic effect, no need to open the chest, less damage, no aortic clipping, and less cerebral ischemic damage.…”

Section: Discussionmentioning

confidence: 99%

Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature

Zhong¹,

Li²

2022

WJCC

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BACKGROUND Aortoesophageal fistula (AEF) is a rare but life-threatening cause of upper gastrointestinal bleeding. Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported. The purpose of this study is to report a case of AEF managed by endovascular aortic repair and review the relevant literature. CASE SUMMARY A 66-year-old man with upper gastroenterology bleeding presented at the Emergency Department of our hospital complaining of chest pain, fever and hematemesis for 6 h. He had vomited 400 mL of bright-red blood and experienced severe chest pain 6 h prior. He had a past medical history of advanced esophageal cancer. He received chemoradiotherapy but stopped 8 mo prior because of intolerance. A chest contrast computed tomographic scan revealed communication between the esophagus and the descending aorta as well as a descending aortic pseudoaneurysm. According to the symptoms and imaging findings, AEF was our primary consideration. The patient underwent aortic angiography, which indicated AEF and descending aortic pseudoaneurysm. Emergency percutaneous thoracic endovascular aortic repair (TEVAR) of the descending aorta was performed, and bleeding was controlled after TEVAR. He received antibiotics and was discharged after treatment. However, he died 2 mo after the TEVAR due to cancer progression. CONCLUSION Although AEF is a lethal condition, timely diagnosis and TEVAR may successfully control bleeding.

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Section: Discussionmentioning

confidence: 99%

Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature

Zhong¹,

Li²

2022

WJCC

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“…There are few published case reports with successful management [ 8 , 9 ]. Upper endoscopy should be performed in the setting of active hematemesis, whereas CT is the initial imaging study of choice for assessing AEF in for hemodynamically stable patient.…”

Section: Discussionmentioning

confidence: 99%

“…Open repair usually involves replacement or bypass of the thoracic aorta with resection and repair of the esophagus. The operative mortality of open AEF repair ranges from 45.4% to 55% [ 8 ] and thus was not used in this case. TEVAR provides essential haemostasis, acting as a bridge to definitive esophagectomy, or as in this case palliative radiation therapy [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Thoracic Endovascular Aortic Repair for a Ruptured Mycotic Aortic Pseudoaneurysm Secondary to Esophageal Carcinoma

Lim

Murphy

Atyani

et al. 2022

Case Reports in Vascular Medicine

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A 47-year-old female presented to the emergency department with new episodes of hematemesis. She had a background of unresectable T4b + N1 + M0 esophageal squamous cell carcinoma. Contrast CT thoracic aorta diagnosed a ruptured mycotic aortic pseudoaneurysm of the descending aorta, forming a life threating aorto-esophageal fistula secondary to neoplasm. Due to the high risk of fatal haemorrhage, she underwent successful emergency thoracic endovascular aortic repair (TEVAR). Mycotic aortic pseudoaneurysms are a rare and often fatal complication of esophageal carcinomas. They represent a small subsection of aorto-esophageal fistulas. Early diagnosis with cross sectional imaging and vascular control of the sentinel bleed is essential for survival. TEVAR may be used as a bridge to palliative treatment in the case of unresectable esophageal carcinoma.

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“…Thoracic endovascular aortic repair (TEVAR), proposed by Dake et al, had a success rate of 87% and a mortality rate of 19%. However, the AEF recurrence rate and the stent infection rates were 13% and 15%, respectively [12]. The use of TEVAR improves survival as a definite measure, particularly in patients whose clinical conditions coexist with increased comorbidities and a higher risk of open surgical procedures [13].…”

Section: Discussionmentioning

confidence: 99%

Hemorrhagic Shock Secondary to Aortoesophageal Fistula as a Complication of Esophageal Cancer

Guerrero

Cuenca

Cardenas

et al. 2020

Cureus

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Although aortoesophageal fistulas are rare, they can present as life-threatening emergencies. This condition can develop secondary to an aneurysm, foreign bodies, infiltrating tumors, and radiotherapy. We report a patient with hemorrhagic shock secondary to an aortoesophageal fistula. A 69-year-old male with squamous cell carcinoma of the esophagus treated with chemoradiation and metallic stent placement was admitted to the intensive care unit (ICU) after an episode of hematemesis. The patient was hemodynamically unstable, requiring fluid resuscitation, blood transfusions, and respiratory and vasopressor support. The patient developed electric pulseless activity, and cardiopulmonary resuscitation was performed for 40 minutes. An upper endoscopy showed the esophageal tumor infiltrating into the stent, and computed tomography (CT) angiogram showed leakage of contrast from the thoracic aorta to the esophagus. The diagnosis of aortoesophageal fistula was made. The patient underwent endovascular management for the fistula. However, his critical condition did not improve, and the patient perished.

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Thoracic Endovascular Aortic Repair of Esophageal Cancer-Associated Aortoesophageal Fistula: A Case Report and Literature Review

Cited by 13 publications

References 9 publications

Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature

Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature

Thoracic Endovascular Aortic Repair for a Ruptured Mycotic Aortic Pseudoaneurysm Secondary to Esophageal Carcinoma

Hemorrhagic Shock Secondary to Aortoesophageal Fistula as a Complication of Esophageal Cancer

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