Aortoesophageal Fistula Secondary to Thoracic Endovascular Aortic Repair of a Descending Aortic Aneurysm Rupture

2011 ◽  
Vol 14 (4) ◽  
pp. 249 ◽  
Author(s):  
Sadan Yavuz ◽  
Muhip Kanko ◽  
Ercument Ciftci ◽  
Hakan Parlar ◽  
Huseyin Agirbas ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Stent Graft ◽  
Aneurysm Rupture ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortoesophageal Fistula ◽  
Descending Thoracic Aortic Aneurysm ◽  
Aortic Repair ◽  
Descending Aortic Aneurysm ◽  
Upper Gastrointestinal

<p><b>Purpose</b>: We present the case of a patient who developed an aortoesophageal fistula (AEF) 4 years after thoracic endovascular aortic repair (TEVAR) of a descending thoracic aortic aneurysm rupture.</p><p><b>Case Report</b>: A 60-year-old female patient underwent emergency stent graft placement in December 2006 because of rupture of a distal descending aortic aneurysm. The patient was discharged uneventfully. Four years later, the patient was readmitted because of recurrent hematemesis, weight loss, and malaise. A computed tomography scan and an upper gastrointestinal system (GIS) endoscopy examination revealed an AEF located at the midportion of the esophagus and at the caudal end of the stent graft. An emergency stent graft was re-replaced into the previous graft. The patient died from hemorrhagic shock due to massive GIS bleeding while she was being prepared for secondary major esophageal surgery.</p><p><b>Conclusion</b>: AEF is a catastrophic complication of TEVAR. Conservative treatment is often associated with fatal results. If possible, these patients should be treated with secondary major surgical procedures.</p>

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

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Akiko Sasaki ◽  
Hideto Egashira ◽  
Shinnosuke Tokoro ◽  
Chikamasa Ichita ◽  
Satoshi Takizawa ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Stent Graft ◽  
Postoperative Management ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Stent Insertion ◽  
Aortoesophageal Fistula ◽  
Bridge To Surgery ◽  
Aortic Repair ◽  
T4 Esophageal Cancer

Background. Thoracic endovascular aortic repair of an aortoesophageal fistula is an effective emergency treatment for patients with T4-esophageal cancer, as it prevents sudden death, and is a bridge to surgery. However, the course of unresectable malignant aortoesophageal fistula treated with thoracic endovascular aortic repair alone is not well-known. Case Presentation. We report a 67-year-old Japanese man with T4-esophageal cancer who experienced a chemoradiation-induced aortoesophageal fistula and was rescued with thoracic endovascular aortic repair. He recovered after the procedure and survived for 4 additional months with management of a mycotic aneurysm and secondary aortoesophageal fistula with the exposure of the stent graft into the esophagus. Thoracic endovascular aortic repair of aortoesophageal fistula with T4-esophageal cancer extended life for nearly an average of 4 months in the reported cases. As a postoperative complication, the exposure of the stent graft into the esophagus is rare but life-threatening; the esophageal stent insertion was effective. Conclusions. With postoperative management advances, thoracic endovascular aortic repair can improve survival and increase the quality of life of patients with T4-esophageal cancer.

scholarly journals An Esophageal Ulcer Associated with a Thoracoabdominal Aortic Aneurysm

2019 ◽  
Vol 13 (1) ◽  
pp. 214-218 ◽  
Author(s):  
Atsuto Kayashima ◽  
Hideki Mori ◽  
Anna Okuzawa ◽  
Yoko Kubosawa ◽  
Yuichiro Hirai ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Endovascular Aortic Repair ◽  
Upper Gastrointestinal Endoscopy ◽  
Aortoesophageal Fistula ◽  
Esophageal Ulcer ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Upper Gastrointestinal ◽  
Very High

An aortoesophageal fistula, an abnormal anatomical communication between the aorta and the esophagus, is a rare cause of upper gastrointestinal bleeding. The mortality rate of patients with this condition is very high. A 77-year-old man, who had undergone endovascular aortic repair for a ruptured abdominal aortic aneurysm, developed melena. An upper gastrointestinal endoscopy was performed. This detected an esophageal ulcer, which had the potential to develop into an aortoesophageal fistula. Therefore, thoracic endovascular aortic repair was performed on the following day. Thereafter, the course was uneventful. We encountered a rare case of an esophageal ulcer associated with a thoracoabdominal aortic aneurysm before it developed into an aortoesophageal fistula.

scholarly journals Predictors and Outcomes of Cardiac Events following Thoracic Endovascular Aortic Repair in Descending Thoracic Aortic Aneurysm and Dissection

Aorta ◽  
2020 ◽  
Vol 08 (01) ◽  
pp. 006-013
Author(s):  
Derrick O. Acheampong ◽  
Philip Paul ◽  
Percy Boateng ◽  
I. Michael Leitman
Keyword(s):  
Risk Factors ◽  
Aortic Aneurysm ◽  
Blood Transfusion ◽  
Thoracic Aortic Aneurysm ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Cardiac Events ◽  
Descending Thoracic Aortic Aneurysm ◽  
Aortic Repair ◽  
Significant Difference

Abstract Background Cardiac events following thoracic endovascular aortic repair (TEVAR) have been associated with significant morbidity and mortality. However, predictors of post-TEVAR cardiac events in descending thoracic aortic aneurysm or dissection are poorly understood. Methods A retrospective analysis of completed TEVAR procedures performed from 2010 to 2016 was conducted using the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) participant user file database. Adult patients (≥18 years) who underwent TEVAR for descending thoracic aortic aneurysm or dissection were identified and 30-day outcomes were examined. An initial univariate analysis was performed to determine associations between all patient variables and cardiac events, defined as myocardial infarction or cardiac arrest that occurred ≤30 days of surgery. Multivariate logistic regression was subsequently performed to identify independent risk factors for cardiac events following TEVAR. Results The study identified 150 out of 2,905 (5.2%) patients who underwent TEVAR for descending thoracic aortic aneurysm or dissection who developed cardiac events. No significant difference in incidence of cardiac events was noted among patients presenting with aortic aneurysm or dissection (p = 0.339). The overall 30-day mortality rate for all patients was 9.1%. Independent preoperative predictors of post-TEVAR cardiac events included emergency procedure (odds ratio [OR] 2.80, 95% confidence interval [CI] 1.9–4.1, p < 0.01); American Society of Anesthesiologists score >3 (OR 1.71, 95% CI 1.1–2.6, p = 0.01), ventilator dependence (OR 2.33, 95% CI 1.3–4.2, p < 0.01), renal failure (OR 2.53, 95% CI 1.50–4.3, p < 0.01), blood transfusion (OR 1.84, 95% CI 1.1–3.2, p = 0.03), and preoperative leukocytosis (OR 2.45, 1.6–3.8, p < 0.01). After TEVAR, unplanned reintubation (OR 5.52, 95% CI 3.5–8.8, p < 0.01), prolonged mechanical ventilation (OR 1.94, 95% CI 1.2–3.2, p = 0.011), and postoperative blood transfusion (OR 4.02, 95% CI 2.70–6.0, p < 0.01) were independent predictors of cardiac events. Cardiac events greatly increased mortality (60.7 vs. 5.5%), total length of hospital stay (13.2 ± 14.7 days vs. 8.3 ± 9.3 days), and readmission rates (19.3 vs. 8.2%, p < 0.01). Conclusions Cardiac events following TEVAR are associated with significant mortality. Patients with these risk factors should be appropriately monitored to improve outcomes.

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