title: Complete coverage of in situ aortograft by total omental pedicle flap as the most reliable treatment of aortoesophageal fistula.
abstract: Aortoesophageal fistula secondary to a thoracic aortic aneurysm is usually a fatal disease with few survivors reported previously. We encountered 2 consecutive patients who were treated successfully with esophagectomy and in situ aorta reconstruction using cryopreserved homograft that was wrapped completely with omental pedicle flap. For the construction of omental flap, the right gastroepiploic artery was resected at the root and all the vessels entering the greater curvature and the transverse colon were resected at the adherent edges. Because the gastroepiploic arcade is totally preserved, large amounts of omental tissue could be obtained, with an excellent blood supply mainly from the left gastroepiploic artery. This type of omental flap is highly mobile, easily transferred to the left hemithorax, and has enough volume to cover the in situ aortic graft completely including anastomosis lines. Thus, our omental coverage appears to be the most reliable method to prevent postoperative graft infection.
authors.affiliation: Department of Surgical Oncology, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo 113-0033, Japan. kitayama-1SU@h.u-tokyo.ac.jp
authors.forename: Joji
authors.initials: J
authors.lastname: Kitayama
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Morota
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kaisaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakayama
authors.forename: Hironori
authors.initials: H
authors.lastname: Ishigami
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Yamashita
authors.forename: Makoto
authors.initials: M
authors.lastname: Ishikawa
authors.forename: Ko
authors.initials: K
authors.lastname: Shibata
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takamoto
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Nagawa
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000637:transplantation*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D004937:Esophageal Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009852:Omentum / Q000637:transplantation*; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous; D016157:Vascular Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*