Aortoesophageal Fistula Secondary to Thoracic Endovascular Aortic Repair of a Descending Aortic Aneurysm Rupture
Purpose: We present the case of a patient who developed an aortoesophageal fistula (AEF) 4 years after thoracic endovascular aortic repair (TEVAR) of a descending thoracic aortic aneurysm rupture.
Case Report: A 60-year-old female patient underwent emergency stent graft placement in December 2006 because of rupture of a distal descending aortic aneurysm. The patient was discharged uneventfully. Four years later, the patient was readmitted because of recurrent hematemesis, weight loss, and malaise. A computed tomography scan and an upper gastrointestinal system (GIS) endoscopy examination revealed an AEF located at the midportion of the esophagus and at the caudal end of the stent graft. An emergency stent graft was re-replaced into the previous graft. The patient died from hemorrhagic shock due to massive GIS bleeding while she was being prepared for secondary major esophageal surgery.
Conclusion: AEF is a catastrophic complication of TEVAR. Conservative treatment is often associated with fatal results. If possible, these patients should be treated with secondary major surgical procedures.
Böckler D, Schumacher H, Ganten M, et al. 2006. Complications after endovascular repair of acute symptomatic and chronic expanding Stanford type B aortic dissections. J Thorac Cardiovasc Surg 132:361-8.nChiesa R, Melissano G, Marone EM, Marrocco-Trischitta MM, Kahlberg A. 2010. Aorto-oesophageal and aortobronchial fistulae following thoracic endovascular aortic repair: a national survey. Eur J Vasc Endovasc Surg 39:273-9.nCzerny M, Zimpfer D, Fleck T, et al. 2005. Successful treatment of an aortoesophageal fistula after emergency endovascular thoracic aortic stent-graft placement. Ann Thorac Surg 80:1117-20.nEggebrecht H, Baumgart D, Radecke K, et al. 2004. Aortoesophageal fistula secondary to stent-graft repair of the thoracic aorta. J Endovasc Ther 11:161-7.nEggebrecht H, Mehta RH, Dechene A, et al. 2009. Aortoesophageal fistula after thoracic aortic stent-graft placement: a rare but catastrophic complication of a novel emerging technique. JACC Cardiovasc Interv 2:570-6.nFanelli F, Dake MD. 2009. Standard of practice for the endovascular treatment of thoracic aortic aneurysms and type B dissections. Cardiovasc Intervent Radiol 32:849-60.nFattori R, Nienaber CA, Rousseau H, et al. 2006. Results of endovascular repair of the thoracic aorta with the Talent Thoracic stent graft: the Talent Thoracic Retrospective Registry. J Thorac Cardiovasc Surg 132:332-9.nFlores J, Shiiya T, Kunihara T, Yoshimoto K, Matsuzaki K, Yasuda K. 2005. Reoperations after failure of stent grafting for type B aortic dissection: report of two cases. Surg Today 35:581-5.nGirdauskas E, Falk V, Kuntze T, et al. 2008. Secondary surgical procedures after endovascular stent grafting of the thoracic aorta: successful approaches to a challenging clinical problem. J Thorac Cardiovasc Surg 136:1289-94.nHansen C, Bui H, Donayre C, et al. 2004. Complications of endovascular repair of high-risk and emergent descending thoracic aortic aneurysms and dissections. J Vasc Surg 40:228-34.nIsasti G, Gómez-Doblas JJ, Olalla E. 2009. Aortoesophageal fistula: an uncommon complication after stent-graft repair of an aortic thoracic aneurysm. Interact Cardiovasc Thorac Surg 9:683-4.nJonker FH, Schlösser FJ, Moll FL, et al. 2009. Outcomes of thoracic endovascular aortic repair for aortobronchial and aortoesophageal fistulas. J Endovasc Ther 16:428-40.nMetz R, Kimmings AN, Verhagen HJ, Rinkes IH, van Hillegersberg R. 2006. Aortoesophageal fistula successfully treated by endovascular stentgraft. Ann Thorac Surg 82:1117-9.nMidulla M, Dehaene A, Godart F, et al. 2008. TEVAR in patients with late complications of aortic coarctation repair. J Endovasc Ther 15:552-7.nPorcu P, Chavanon O, Sessa C, Thony F, Aubert A, Blin D. 2005. Esophageal fistula after endovascular treatment in a type B aortic dissection of the descending thoracic aorta. J Vasc Surg 41:708-11.nRiesenman PJ, Farber MA, Mendes RR, et al. 2005. Endovascular repair of lesions involving the descending thoracic aorta. J Vasc Surg 42:1063-74.n
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