Primary aortoesophageal fistula secondary to thoracic aneurysm. Successful surgical treatment by extra-anatomic bypass grafting.
Aortoesophageal fistula (AEF) secondary to thoracic aneurysm is rare, and is usually fatal without prompt surgical intervention, with few survivors reported. Here we report a case of a 68-year-old woman late-presenting AEF successfully treated by extra-anatomic bypass grafting. Since she had already a mediastinal infection caused by AEF on admission, we performed extra-anatomic bypass grafting from the ascending aorta to the infrarenal aorta, and primary esophageal repair. The extra-anatomic bypass grafting was performed to avoid the risk to secondary graft infection and to decrease the total ishemic time induced by intraoperative aortic clamping, which is necessary when in-situ graft replacement is chosen. Although only 17 cases (including the present case) have been reported as long-term survivors, most have involved in-situ repair of the thoracic aneurysm. To our knowledge, the present case was only the second treated successfully by extra-anatomic bypass grafting. We recommend extra-anatomic bypass grafting for a case with severe infection and prolonged hypoperfusion insult caused by massive bleeding due to rupture in an aneurysm.
Taniguchi
Iwao
I
Department of Thoracic and Cardiovascular Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori 680-9010, Japan.
Takemoto
Naoaki
N
Yamaga
Takeshi
T
Morimoto
Keisuke
K
Miyasaka
Shigeto
S
Suda
Takako
T
D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications*; D001018:Aortic Diseases / Q000209:etiology / Q000601:surgery*; D004937:Esophageal Fistula / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D019616:Thoracic Surgical Procedures / Q000379:methods; D016157:Vascular Fistula / Q000209:etiology / Q000601:surgery*