Aortoesophageal fistula secondary to stent-graft repair of the thoracic aorta.
OBJECTIVE
To report the incidence and management of aortoesophageal fistula (AEF) secondary to endovascular stent-graft repair of the descending thoracic aorta.


METHODS
A retrospective review was conducted of patients treated at our facility between July 1999 and June 2003. During this interval, 60 patients (46 men; average age 66+/-10 years) underwent thoracic aortic stent-graft placement for a variety of pathologies.


RESULTS
AEF occurred in 3 (5%) patients. One 62-year-old man presented with recurrent back pain and fever and died suddenly due to fatal exsanguination; the AEF was revealed at necropsy. The other 2 patients (both women) presented with hematemesis after endovascular repair of thoracic aortic aneurysms. AEF was detected by esophagogastroduodenoscopy. Both patients were treated conservatively, as open surgical repair was refused because of their general condition. Both patients developed severe mediastinitis and died after 5 weeks and 10 months, respectively.


CONCLUSIONS
Aortoesophageal fistula is, in our experience, a catastrophic complication of endovascular stent-graft placement. Treatment options are very limited, as these patients are usually not candidates for open surgery. Outcome under conservative management is, however, almost invariably fatal.
Eggebrecht
Holger
H
Department of Cardiology, West-German Heart Center, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany. holger.eggebrecht@uni-essen.de
Baumgart
Dietrich
D
Radecke
Klaus
K
von Birgelen
Clemens
C
Treichel
Ulrich
U
Herold
Ulf
U
Hunold
Peter
P
Gerken
Guido
G
Jakob
Heinz
H
Erbel
Raimund
R
D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000601:surgery*; D001018:Aortic Diseases / Q000209:etiology*; D001019:Aortic Rupture / Q000150:complications / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D004937:Esophageal Fistula / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D015607:Stents / Q000009:adverse effects*; D014652:Vascular Diseases / Q000209:etiology*