Aorto-duodenal fistula secondary to aortic graft replacement

Abstract Background Aortoesophageal fistula(AEF) had been a critical and life-threatening disease. The surgical strategy which consist of aortic graft replacement with omental wrapping, esophagectomy, and staged esophageal reconstruction achieve circulatory recovery, infection control and long term survival. The objective of this study is to evaluate surgical outcomes of pedicled jejunal transfer with microvascular augmentation as esophageal reconstruction for AEF. Methods 14 patients with aortoesophageal fistula who underwent aortic graft replacement and esophagectomy between 2010 and 2017 at Kobe University Hospital and affiliate hospitals were enrolled in this study. Patient characteristics, operative method and clinical outcomes were obtained by retrospective chart review. Results All 14 patients underwent aortic graft replacement with omental wrapping, esophagectomy and staged esophageal reconstruction. 10 patients (71.4%) successfully underwent staged esophageal reconstruction of pedicled jejunal transfer with microvascular augmentation and showed no leakage and no graft loss. Median survival time in the patients who underwent esophageal reconstruction was 20.3 months from initial operation. Nine of 10 patients were alive but one patient died of sepsis ten months after esophageal reconstruction. Conclusion Aortic graft replacement with omental wrapping and esophaegcotomy play crucial role in the treatment of AEF. Omentum is pedicled by right epiploic artery and vein to prepare good blood flow and sufficient volume of omental wraping and, consequently, stomach without right epiploic artery and vein becomes inappropriate for esophageal conduit. Pedicled jejunal transfer with microvascular augmentation contributes good post-operative outcome. The surgical strategy for AEF, which includes aortic graft replacement with omental wrapping, esophagectomy, and staged esophageal reconstruction by pedicled jejunal transfer microvascular augmentation is feasible and promising. Disclosure All authors have declared no conflicts of interest.

Download Full-text

Duodenal fistula—A rare complication following the removal of an infected aortic graft: Case report

CardioVascular and Interventional Radiology ◽

10.1007/bf02576982 ◽

1986 ◽

Vol 9 (1) ◽

pp. 33-36 ◽

Cited By ~ 3

Author(s):

C. Hannig ◽

B. Allgayer ◽

M. Risch ◽

T. Holzmann ◽

J. Dörrler ◽

...

Keyword(s):

Case Report ◽

Rare Complication ◽

Aortic Graft ◽

Duodenal Fistula

Download Full-text

Beating-heart ascending aortic graft replacement in dilated cardiomyopathy

Interactive Cardiovascular and Thoracic Surgery ◽

10.1510/icvts.2009.204875 ◽

2009 ◽

Vol 9 (2) ◽

pp. 384-386

Author(s):

H. Imagawa ◽

F. Shikata ◽

M. Ryugo ◽

K. Kawachi

Keyword(s):

Dilated Cardiomyopathy ◽

Beating Heart ◽

Aortic Graft ◽

Graft Replacement

Download Full-text

Lung Cancer Resection or Aortic Graft Replacement With Simultaneous Myocardial Revascularization Without Cardiopulmonary Bypass

CHEST Journal ◽

10.1378/chest.119.6.1941 ◽

2001 ◽

Vol 119 (6) ◽

pp. 1941-1943 ◽

Cited By ~ 5

Author(s):

Amir Elami ◽

Amit Korach ◽

Ehud Rudis

Keyword(s):

Lung Cancer ◽

Cardiopulmonary Bypass ◽

Myocardial Revascularization ◽

Aortic Graft ◽

Graft Replacement ◽

Cancer Resection

Download Full-text

Prosthetic aortic graft replacement of the ascending thoracic aorta alters biomechanics of the native descending aorta as assessed by transthoracic echocardiography

PLoS ONE ◽

10.1371/journal.pone.0230208 ◽

2020 ◽

Vol 15 (3) ◽

pp. e0230208 ◽

Cited By ~ 3

Author(s):

Maria C. Palumbo ◽

Lisa Q. Rong ◽

Jiwon Kim ◽

Pedram Navid ◽

Razia Sultana ◽

...

Keyword(s):

Thoracic Aorta ◽

Transthoracic Echocardiography ◽

Aortic Graft ◽

Graft Replacement ◽

Descending Aorta

Download Full-text

Risk Factors for Mortality in Patients with Aortoesophageal Fistula Related to Aortic Lesions

Gastroenterology Research and Practice ◽

10.1155/2020/4850287 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Shan Li ◽

Feng Gao ◽

Hai-ou Hu ◽

Jin Shi ◽

Jie Zhang

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Conservative Treatment ◽

Hemorrhagic Shock ◽

Multiorgan Failure ◽

Diagnostic Methods ◽

Cochrane Library ◽

Aortoesophageal Fistula ◽

Aortic Graft ◽

Graft Replacement

Objective. Aortoesophageal fistula (AEF) related to aortic aneurysm and dissection is an uncommon but life-threatening condition. We performed a systematic review of risk factors for mortality and factors associated with the prognosis of AEF. Methods. A systematic search of the PubMed, Embase, and Cochrane Library databases was performed. Clinical characteristics, diagnostic methods, and treatments were assessed in terms of their ability to predict mortality. Results. The systematic review identified 184 eligible articles including 219 patients with AEF. Multivariable Cox regression revealed positive correlations of hemorrhagic shock (hazard ratio (HR): 1.824, 95% CI: 1.217-2.735, P=0.004), sepsis (HR: 1.714, 95% CI: 1.112-2.641, P=0.015), multiorgan failure (HR: 3.060, 95% CI: 1.470-6.368, P=0.003), and conservative treatment (HR: 5.257, 95% CI: 3.405-8.116, P<0.001) with mortality and a negative correlation between combination therapy (aortic graft replacement and esophagectomy) and mortality (HR: 0.319, 95% CI: 0.125-0.813, P=0.017). Kaplan–Meier survival analysis showed that the 1-year cumulative survival rate was 42.5±3.8%. The overall fistula-related mortality rate was 47.0% (103/219). The most common causes of death were bleeding (54.9%) and infection (29.2%). Conclusions. We found that hemorrhagic shock, sepsis, and multiorgan failure were risk factors for death in patients with AEF. Additionally, conservative treatment was associated with a higher rate of mortality, while combined aortic graft replacement and esophagectomy improved the prognosis.

Download Full-text