title: Emergent endovascular stent grafting for saccular arch aneurysm complicated by aorto-esophageal fistula.
abstract: Aneurysms of aortic arch are rare but amenable to endovascular therapy. Arch aneurysm presenting with aorto-esophageal fistula and hematemesis is a feared, but relatively rare complication. The extrapolation of the safety and rapidity of emergent endovascular repair for bleeding arch aneurysms has been infrequently reported. A bovine arch anatomy confers distinct advantages for endovascular therapy often avoiding a preceding debranching surgery. However, its endovascular treatment might be complicated by the nonhealing of fistula and potential risk for mediastinitis. Here, we report a case of a bovine aortic arch cystic aneurysm complicated by bleeding aorto-esophageal fistula, which warranted an emergent endovascular therapy. The prevertebral part of LSCA was plugged to interrupt the retrograde filling and a future endoleak. A nonhealing aorto-mediastinal fistula at follow-up was successfully treated by covered esophageal stenting. This report reiterates the importance of multidisciplinary approach with multispecialty collaboration to such complex spectrum of diseases.
authors.affiliation: Senior Consultant and Head, Department of Cardiology, Rajagiri Hospital, Chunangamvely, Aluva, Kochi, Kerala 683112, India. Electronic address: ramdasnayakh@gmail.com.
authors.forename: Ram Das
authors.initials: RD
authors.lastname: Nayak
authors.affiliation: Consultant, Department of Cardiology, Rajagiri Hospital, Chunangamvely, Aluva, Kochi, Kerala 683112, India.
authors.forename: Mathews
authors.initials: M
authors.lastname: Paul
authors.affiliation: Consultant, Department of Cardiothoracic and Vascular Surgery, Rajagiri Hospital, Chunangamvely, Aluva, Kochi, Kerala 683112, India.
authors.forename: George Jose
authors.initials: GJ
authors.lastname: Valooran
authors.affiliation: Consultant, Department of Gastroenterology, Rajagiri Hospital, Chunangamvely, Aluva, Kochi, Kerala 683112, India.
authors.forename: Rosh
authors.initials: R
authors.lastname: Varghese
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D003952:Diagnostic Imaging; D057510:Endovascular Procedures; D004937:Esophageal Fistula / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D015607:Stents
keywords: Aorto-esophageal fistula; Arch aneurysm; Endovascular stent; Esophageal stent