Aortoesophageal fistula secondary to mycotic thoracic aortic aneurysm: endovascular repair and transhiatal esophagectomy.
OBJECTIVE
To report a case of aortoesophageal fistula secondary to a mycotic thoracic aortic aneurysm (TAA) successfully repaired by stent-grafting of the descending thoracic aorta.


METHODS
A 66-year-old woman with a recent history of hemicolectomy for colon cancer complicated by postoperative infection presented with midthoracic pain, fever, hoarseness, and blood chemistries consistent with an inflammatory process. Imaging showed a widened mediastinum and displacement of the trachea due to a mycotic thoracic aneurysm; endoscopy confirmed a large fistula in the esophageal wall. There was no active bleeding, so an Excluder thoracic endograft was positioned in the aortic arch, partially covering the left subclavian artery origin. Three days later, a transhiatal esophagectomy was performed. Intravenous antibiotic therapy was continued for 6 weeks. At 18 months, a minithoracotomy was performed because of extreme dyspnea. An aneurysm sac hygroma was drained in the thoracic cavity. At 2 years, the patient was well, and there were no signs of infection or dyspnea.


CONCLUSIONS
Along with a transhiatal esophagectomy, we suggest that endovascular stent-grafting has a place as a minimally invasive technique in the treatment of aortoesophageal fistula secondary to aneurysm of the thoracic aorta.
Van Doorn
Ruth C
RC
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Reekers
Jim
J
de Mol
Bas A J M
BA
Obertop
Huug
H
Balm
Ron
R
D000368:Aged; D000785:Aneurysm, Infected / Q000150:complications*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications*; D001018:Aortic Diseases / Q000209:etiology* / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D003015:Clostridium Infections / Q000150:complications*; D004937:Esophageal Fistula / Q000209:etiology* / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D015607:Stents; D016157:Vascular Fistula / Q000209:etiology* / Q000628:therapy*