Aortoesophageal fistula following TEVAR: Celerity of a multidisciplinary approach and its prognostic implications
DOI:
https://doi.org/10.48750/acv.483Palavras-chave:
Aortic aneurysm, endovascular, graft infection, aortoesophageal fistula, thoracic aortaResumo
INTRODUCTION: Secondary Aortoesophageal fistula (AEF) is a rare but serious complication following thoracic endovascular aneurysm repair (TEVAR), which may lead to fatal outcomes.
CASE REPORT: We present the case of a 62-year-old patient developing a secondary AEF one-month after TEVAR. The patient was managed in a staged approach: first, an oesophagus defunctionalisation by cervical oesophagus stapling, followed by drainage gastrostomy and creation of a feeding jejunostomy. Two-weeks later, the patient underwent stent graft explantation, extensive debridement, in situ aortic reconstruction with interposition of a silver and Triclosan impregnated Dacron graft, esophagectomy, eosophagogastrostomy and intercostal muscle flap plasty. After 4 years of follow-up, the patient remains clinically well and free from recurrence.
CONCLUSION: The diagnosis of AEF requires a high index of suspicion. A prompt and aggressive multidisciplinary approach is necessary to obtain long-term survival and freedom from recurrence.
Downloads
Referências
Kay MD, Davies B, Patel K, Gourevitch D. Aorto-oesophageal fistula following TEVAR: an unusual cause of mediastinal air. BMJ Case Rep. 2013: bcr2013009268.
Sladojevic M, Bjelovic M, Ilic N, Mutavdzic P, Koncar I, Dragas M, Markovic M, Davidovic L. Open Surgical Treatment of Secondary Aortoesophageal and Aortobronchial Fistula after Thoracic Endovascular Aortic Repair and Esophagocoloplasty in a Second Procedure. Ann Vasc Surg. 2017; 44: 417.e11-417.e16.
Albors J, Bahamonde JÁ, Sanchis JM, Boix R, Palmero J. Aortoesophageal fistula after thoracic stent grafting. Asian cardiovascular & thoracic annals, 2011. 19(5), 352–356.
Slieker FJB, Ruurda JP, Hazenberg CEVB. Esophageal Resection, Gastric Tube Reconstruction, and Omental Flap Coverage of Iatrogenic Aortoesophageal Fistula After Secondary Thoracic Stentgraft Infection: A Case Report. Ann Vasc Surg. 2019; 59: 314.e1-314.e4.
Vallabhajosyula P, Komlo C, Wallen T, Szeto WY. Two-stage surgical strategy for aortoesophageal fistula: emergent thoracic endovascular aortic repair followed by definitive open aortic and esophageal reconstruction. J Thorac Cardiovasc Surg. 2012; 144(5): 1266-8.
Kouritas VK, Dedeilias P, Sotiriou K, Klimopoulos S. Delayed presentation of aortoesophageal fistula after endovascular repair. Asian Cardiovasc Thorac Ann. 2016; 24(1): 51-3.
De Masi M, Amabile P, Bal L, Piquet P. Management of endograft infection coupled with aortoesophageal fistula: extra-anatomic aortic bypass and endograft explantation. J Thorac Cardiovasc Surg. 2013; 146(3): e11-3.
Czerny M, Eggebrecht H, Sodeck G, Weigang E, Livi U, Verzini F, Schmidli J, Chiesa R, Melissano G, Kahlberg A, Amabile P, Harringer W, Horacek M, Erbel R, Park KH, Beyersdorf F, Rylski B, Blanke P, Canaud L, Khoynezhad A, Lonn L, Rousseau H, Trimarchi S, Brunkwall J, Gawenda M, Dong Z, Fu W, Schuster I, Grimm M. New insights regarding the incidence, presentation and treatment options of aorto-oesophageal fistulation after thoracic endovascular aortic repair: the European Registry of Endovascular Aortic Repair Complications. Eur J Cardiothorac Surg. 2014; 45(3): 452-7.
Canaud L, Alric P, Gandet T, Ozdemir BA, Albat B, Marty-Ane C. Open surgical secondary procedures after thoracic endovascular aortic repair. Eur J Vasc Endovasc Surg. 2013; 46(6): 667-74.
