title: Successful therapy of brachiocephalic arteriogastric fistula after esophagectomy.
abstract: We report the case of an 86-year-old man, who had undergone subtotal esophagectomy and reconstruction with a gastric tube through the retrosternal route 7 years ago, who was referred for treatment of a brachiocephalic arteriogastric fistula. An emergency stent-graft placement was performed to prevent massive bleeding from the fistula. After 2 weeks, a follow-up esophagogastroscopy revealed that the gastric tube ulcer had been penetrated, and the stent graft was exposed. Therefore, surgical treatment was indicated. After a carotid-carotid arterial bypass graft was made, the brachiocephalic artery was resected with the stent graft and the gastric wall. The defect between the cervical esophagus and the remnant gastric tube was replaced by a free jejunal graft. The patient tolerated these procedures well and was transferred to the referral hospital 3 months after surgery. Therefore, both an early diagnosis and the administration of multidisciplinary treatment are essential to save patients presenting with an arterioenteric fistula.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Nagai
authors.forename: Masayuki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Osamu
authors.initials: O
authors.lastname: Ikeda
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nakasone
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakaguchi
authors.forename: Ryuji
authors.initials: R
authors.lastname: Kunitomo
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D000792:Angiography; D001807:Blood Vessel Prosthesis; D016122:Brachiocephalic Trunk; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D004947:Esophagus / Q000601:surgery; D005500:Follow-Up Studies; D005747:Gastric Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007583:Jejunum / Q000637:transplantation*; D008297:Male; D015607:Stents; D013270:Stomach / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016157:Vascular Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*