title: Arterio-oesophageal fistula caused by aberrant right subclavian artery aneurysm.
abstract: A 63-year old man had dysphagia for 4 months and was admitted to our hospital with sudden haematemesis. Computed tomography revealed an aberrant right subclavian artery (ARSA) aneurysm and free air inside the aneurysm. Arterio-oesophageal fistula was diagnosed, and an emergency operation was performed. Before thoracotomy, a percutaneous transluminal angioplasty (PTA) balloon was inserted from the right brachial artery and placed at the orifice of the ARSA to control bleeding. Through a left thoracotomy, the aorta was excised and the orifice of the ARSA was exposed. There was no sign of infection in the operative field. Bleeding from the ARSA was controlled by balloon occlusion. The proximal portion of the right vertebral artery was ligated and blood backflow from the ARSA stopped. The ARSA was ligated proximal to the aneurysm, and the orifice of the ARSA to the aorta was closed. The infected aneurysm was not resected. The descending aorta was replaced by a rifampin-bonded artificial graft, and omentopexy was performed. Gastrostomy was performed for decompression of the oesophagus and enteric feeding. Three months after the operation, gastrointestinal endoscopy showed a healed oesophageal ulcer, and the patient was discharged uneventfully.
authors.affiliation: Department of Surgery, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan. shiny@mte.biglobe.ne.jp
authors.forename: Shinya
authors.initials: S
authors.lastname: Takahashi
authors.forename: Kenji
authors.initials: K
authors.lastname: Okada
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Orihashi
authors.forename: Taijiro
authors.initials: T
authors.lastname: Sueda
mesh_terms: D000783:Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D000800:Angioplasty, Balloon; D019917:Blood Vessel Prosthesis Implantation; D018376:Cardiovascular Abnormalities / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003680:Deglutition Disorders / Q000150:complications* / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D004750:Enteral Nutrition; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005774:Gastrostomy; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D013348:Subclavian Artery / Q000002:abnormalities* / Q000601:surgery; D013908:Thoracotomy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery
keywords: Aberrant right subclavian artery aneurysm; Arterio-oesophageal fistula; Gastrostomy; Percutaneous transluminal angioplasty balloon