title: Repair of aortoesophageal fistula after total aortic arch grafting.
abstract: This case report describes the repair of an aortoesophageal fistula caused by a previously placed aortic arch graft. A 62-year-old man underwent total aortic arch graft replacement one year ago. He was readmitted with hematemesis and a high fever. Examination by endoscopy revealed a perforation and two swollen lesions in the mid-esophagus. With the diagnosis of aortoesophageal fistula, the patient underwent esophagectomy, cervical esophagostomy, and gastrostomy with plans for esophageal continuity. Twenty days later, the patient had the graft replacement. Left thoracotomy was performed at the fourth intercostal space and the incision was extended to a sternal transection. The old aortic arch graft was replaced with a rifampicin-bonded gelatin-sealed Dacron graft. After successful esophageal reconstruction (a cervical esophagogastrostomy with the stomach in the substernal position), he fully recovered from surgery. Aortoesophageal fistula is rare and always fatal if surgical intervention is not attempted. When homografts are unavailable, an alternative therapeutic approach is in situ replacement with a rifampicin-bonded gelatin-sealed Dacron graft.
authors.affiliation: Division of Cardiovascular Surgery, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan. yamanaka@tenriyorozu-hp.or.jp
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Michihito
authors.initials: M
authors.lastname: Nonaka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Iwakura
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Asao
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D020878:Device Removal; D013505:Digestive System Surgical Procedures; D004937:Esophageal Fistula / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D016629:Esophagectomy; D004945:Esophagoscopy; D004946:Esophagostomy; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D018720:Prevotella / Q000302:isolation & purification; D011474:Prosthesis Design; D012086:Reoperation; D013908:Thoracotomy; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000209:etiology / Q000382:microbiology / Q000601:surgery*