Management of an aorto-esophageal fistula, complicating a descending thoracic aortic aneurysm endovascularly repaired.
Aorto-esophageal fistula (AEF) is a rare but devastating complication of thoracic aorta endovascular repair (TEVAR). We report a case of a 64-year-old male who presented with chest pain and high CRP levels 10 months after TEVAR for a 9 cm diameter descending thoracic aortic aneurysm. The diagnosis of an AEF was confirmed and the patient was treated conservatively with broad spectrum antibiotics and total parental alimentation. After control of sepsis was achieved, esophagectomy with gastric tube reconstruction was performed and an omental pedicle was used to cover the aortic wall. No intervention to the aorta was made at that time due to the potentially infected mediastinum. The patient's recovery was uneventful and 2 years postoperatively he is in good condition and lives a normal life. Esophagectomy seems to be a mandatory stage of treatment in the setting of AEF. In cases where signs of graft infection are persistent, aortic surgery might be also necessary.
Department of Surgery-Vascular Surgery Unit, Medical School, University of Ioannina, S. Niarchos Avenue, 45110, Ioannina, Greece.
Vaia K
VK
Georvasili
Department of Surgery-Vascular Surgery Unit, Medical School, University of Ioannina, S. Niarchos Avenue, 45110, Ioannina, Greece.
Christina
C
Bali
Department of Surgery-Vascular Surgery Unit, Medical School, University of Ioannina, S. Niarchos Avenue, 45110, Ioannina, Greece.
Michalis
M
Peroulis
Department of Surgery-Vascular Surgery Unit, Medical School, University of Ioannina, S. Niarchos Avenue, 45110, Ioannina, Greece.
George
G
Kouvelos
Department of Surgery-Vascular Surgery Unit, Medical School, University of Ioannina, S. Niarchos Avenue, 45110, Ioannina, Greece.
Stavros
S
Avgos
Department of Surgery-Vascular Surgery Unit, Medical School, University of Ioannina, S. Niarchos Avenue, 45110, Ioannina, Greece.
Dimitris
D
Godevenos
3rd Department of Surgery, Medical School, National University of Athens, Athens, Greece.
Theodoros
T
Liakakos
Department of Surgery-Vascular Surgery Unit, Medical School, University of Ioannina, S. Niarchos Avenue, 45110, Ioannina, Greece. milmats@gmail.com.
Miltiadis
M
Matsagkas
D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000209:etiology / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects*; D004937:Esophageal Fistula / Q000209:etiology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000209:etiology / Q000601:surgery*
Aorto-esophageal fistula; Graft infection; TEVAR; Thoracic aneurysm