Thoracic Endovascular Repair for Aorto-Esophageal Fistula in Patients With Esophageal Carcinoma

Abstract

Aorto-esophageal fistula (AEF) is a rare complication of esophageal carcinoma. Left untreated, it may be lethal due to massive upper gastrointestinal bleeding, while open thoracic surgery is associated with high operative mortality and morbidity. In contrast, thoracic endovascular aortic repair (TEVAR) for AEF is less invasive than open thoracic surgery. Here, we report 3 successful cases of AEF with esophageal carcinoma treated using TEVAR under local anesthesia in the emergent or urgent phase. General condition of all the patients was dramatically improved, but 1 patient with exsanguinations developed infection of the implanted stent-graft and died due to sepsis. The other 2 patients were treated before esophageal bleeding and remained alive for 1 year without infection. The TEVAR should be considered as early as possible in patients with advanced esophageal carcinoma receiving radiation or chemotherapy who develop early signs of AEF such as symptoms of chest discomfort or descending aortic irregularity on computed tomography scan.

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

“…There appears to be a protective role for esophageal stent insertion 1 to 2 weeks after TEVAR. Ishikawa et al reported a successful combined treatment of AEF with TEVAR and an esophageal stent in 2 patients who subsequently achieved 12 and 6 months of survival [9]. In the present case, if stenosis had been present in the esophagus at the time of AEF, it would have been useful to insert a preventive esophageal stent after TEVAR.…”

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

“…A patient with AEF may die due to infection, even when TEVAR is performed[ 23 , 24 , 28 ], and prevention of infection is a challenge after TEVAR. Some studies have suggested lifelong antibiotic suppression, which has many side effects, such as gut dysbiosis.…”

Massive hemorrhage following definitive esophageal chemoradiation: teaching case of a fatal aortoesophageal fistula and lessons learned

“…Although surgery remains the definitive management of AEF , many patients, like this one, are not surgical candidates at presentation. Thoracic endovascular aortic repair (TEVAR) is a rapid, less invasive, and effective alternative to surgical intervention in the urgent and emergent management of patients with AEF and can be used as a bridge to definitive surgical management . TEVAR involves advancing a folded endovascular stent graft through the lumen of an access vessel, usually the femoral artery, inside a delivery sheath before ultimate expansion and deployment in the thoracic or thoracoabdominal aorta.…”