title: Primary aortoesophageal fistula secondary to thoracic aneurysm. Successful surgical treatment by extra-anatomic bypass grafting.
abstract: 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.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori 680-9010, Japan.
authors.forename: Iwao
authors.initials: I
authors.lastname: Taniguchi
authors.forename: Naoaki
authors.initials: N
authors.lastname: Takemoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamaga
authors.forename: Keisuke
authors.initials: K
authors.lastname: Morimoto
authors.forename: Shigeto
authors.initials: S
authors.lastname: Miyasaka
authors.forename: Takako
authors.initials: T
authors.lastname: Suda
mesh_terms: 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*