title: Successful Multistaged Surgical Management of Secondary Aortoesophageal Fistula With Graft Infection.
abstract: Secondary aortoenteric fistula is a rare and dreaded complication of aortic graft replacement. This case demonstrates successful management of a patient with thoracic aortic graft infection resulting in aortoesophageal fistula and the feasibility of combined endovascular approach as a temporary measure to stabilize the patient in extremis, followed by a definitive surgical repair. The patient had a remote history of descending aortic repair and an emergent thoracic endovascular aortic repair for upper gastrointestinal bleeding 2 months ago. We performed a three-staged operation involving extraanatomic bypass, total infected aortic graft excision, and primary closure of the esophageal perforation with muscle flap coverage, from which he eventually recovered.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Texas.
authors.forename: Rana O
authors.initials: RO
authors.lastname: Afifi
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Texas.
authors.forename: Harith H
authors.initials: HH
authors.lastname: Mushtaq
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Texas.
authors.forename: Harleen K
authors.initials: HK
authors.lastname: Sandhu
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Texas; Memorial Hermann Heart & Vascular Institute-Texas Medical Center, Houston, Texas.
authors.forename: Kamal
authors.initials: K
authors.lastname: Khalil
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Texas; Memorial Hermann Heart & Vascular Institute-Texas Medical Center, Houston, Texas.
authors.forename: Hazim J
authors.initials: HJ
authors.lastname: Safi
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston, Houston, Texas; Memorial Hermann Heart & Vascular Institute-Texas Medical Center, Houston, Texas. Electronic address: anthony.l.estrera@uth.tmc.edu.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Estrera
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001013:Aorta, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000209:etiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods; D004937:Esophageal Fistula / Q000209:etiology / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000150:complications* / Q000188:drug therapy; D011552:Pseudomonas Infections / Q000150:complications* / Q000188:drug therapy; D013524:Surgical Flaps; D013736:Testicular Neoplasms; D016157:Vascular Fistula / Q000209:etiology / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents