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Saisho K, Mori N, Nakagawa M, Nakamura E, Tanaka Y, Kaku H, Tanaka Y, Isobe T, Otsuka H, Sudo T, Sakai H, Ishibashi N, Hisaka T, Tayama E, Fujita F. Aortoesophageal fistula due to esophageal cancer: a case report of successful management. Surg Case Rep 2024; 10:88. [PMID: 38630370 PMCID: PMC11024079 DOI: 10.1186/s40792-024-01893-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare but potentially life-threatening condition. The best treatment for the AEF due to esophageal carcinoma is still unresolved. Here, we report a rare case of AEF caused by esophageal cancer, that was successfully treated with emergency thoracic endovascular aortic repair (TEVAR), followed by esophagectomy and gastric tube reconstruction. CASE PRESENTATION A 64-year-old man presented with loss of consciousness and hypotension during chemoradiotherapy for advanced esophageal cancer. Enhanced computed tomography showed extravasation from the descending aorta into the esophagus at the tumor site. We performed emergency TEVAR for the AEF, which stabilized the hemodynamics. We then performed thoracoscopic subtotal esophagectomy on day 4 after TEVAR to prevent graft infection, followed by gastric tube reconstruction on day 30 after TEVAR. At 9 months after the onset of AEF, the patient continues to receive outpatient chemotherapy and leads a normal daily life. CONCLUSION TEVAR is a useful hemostatic procedure for AEF. If the patient is in good condition and can continue treatment for esophageal cancer, esophagectomy and reconstruction after TEVAR should be performed to prevent graft infection and maintain quality of life.
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Affiliation(s)
- Kohei Saisho
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Naoki Mori
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Masashi Nakagawa
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Eiji Nakamura
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yu Tanaka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hideaki Kaku
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yuya Tanaka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Taro Isobe
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hiroyuki Otsuka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tomoya Sudo
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hisamune Sakai
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Nobuya Ishibashi
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Toru Hisaka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Fumihiko Fujita
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
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Sakai M, Sohda M, Uchida S, Yamaguchi A, Watanabe T, Saito H, Nakazawa N, Kuriyama K, Sano A, Ogawa H, Yokobori T, Nagai K, Shirabe K, Saeki H. Efficacy of thoracic endovascular aortic repair for aorto-esophageal fistula due to esophageal cancer: a systematic review and meta-analysis. Esophagus 2024; 21:95-101. [PMID: 38302854 DOI: 10.1007/s10388-024-01042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/31/2023] [Indexed: 02/03/2024]
Abstract
Aorto-esophageal fistula (AEF) due to esophageal cancer (EC) is a life-threatening condition characterized by sudden hemorrhage, which often causes sudden death. To evaluate the efficacy and safety of thoracic endovascular aortic repair (TEVAR) for AEF due to EC, we performed a systematic review and meta-analysis. We searched the MEDLINE (PubMed) databases, the Cochrane Library databases, Ichushi-Web (the databases of the Japan Medical Abstract Society), and CiNii (Academic information search service of the National Institute of Information from Japan) from January 2000 to November 2023 for articles about TEVAR for an emergent aortic hemorrhage (salvage TEVAR [S-TEVAR]), and the prophylactic procedure (P-TEVAR). Six studies (140 cases) were eligible for meta-analysis. The 90-day mortality of S-TEVAR and P-TEVAR was 40% (95% CI 23-60, I2 = 36%) and 8% (95% CI 3-17, I2 = 0%), respectively. Post-S-TEVAR hemorrhagic and infectious complications were 17% (95% CI 3-57, I2 = 71%) and 20% (95% CI 5-57, I2 = 66%), respectively. Post-P-TEVAR hemorrhagic and infectious complications were 2% (95% CI 0-10, I2 = 0%) and 3% (95% CI 1-12, I2 = 0%), respectively. TEVAR for AEF due to EC may be a useful therapeutic option to manage or prevent hemorrhagic oncological emergencies.
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Affiliation(s)
- Makoto Sakai
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Makoto Sohda
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Shintaro Uchida
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Arisa Yamaguchi
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takayoshi Watanabe
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hideyuki Saito
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Nobuhiro Nakazawa
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kengo Kuriyama
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Akihiko Sano
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroomi Ogawa
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | | | - Kazue Nagai
- Gunma University Center for Food Science and Wellness, Maebashi, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hiroshi Saeki
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Owczarek AD, Viniol S, König AM, Görlach J, Denzer UW, Stathopoulos P, Mahnken AH. pTEVAR of an aorto-esophageal fistula in esophageal cancer: Case report and review of the literature. Radiol Case Rep 2023; 18:2526-2530. [PMID: 37235084 PMCID: PMC10208794 DOI: 10.1016/j.radcr.2023.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/28/2023] Open
Abstract
An aorto-esophageal fistula (AEF) is a rare and life-threatening situation, associated with aneurysms, foreign bodies, infiltrating tumors, and radiotherapy. The ideal management is unclear. Open surgery of AEF has a high mortality and morbidity. Thoracic endovascular aortic repair (TEVAR) of an AEF is an effective and safe emergency treatment for these patients. We describe a case of AEF due to esophageal cancer successfully treated the first time by total percutaneous TEVAR (pTEVAR). A 70-year-old male patient presented with massive hematemesis at the emergency department. The patient had a known history of esophageal cancer previously treated by radiochemotherapy which was completed 3 days before. Emergency upper gastrointestinal endoscopy failed to stop the bleeding. Subsequent contrast-enhanced computed tomography revealed an aorto-esophageal fistula and emergency pTEVAR was performed. The bleeding stopped directly after stent graft placement and the patient was discharged after 10 days later. He died 3 months after pTEVAR from cancer progression. pTEVAR is an effective and safe treatment option for AEF. It can be applied as a first-line treatment and offers the potential to improve survival in the emergency setting.
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Affiliation(s)
- Andreas D. Owczarek
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Baldingerstrasse, D-35043, Marburg, Germany
| | - Simon Viniol
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Baldingerstrasse, D-35043, Marburg, Germany
| | - Alexander M. König
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Baldingerstrasse, D-35043, Marburg, Germany
| | - Jannis Görlach
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Baldingerstrasse, D-35043, Marburg, Germany
| | - Ulrike W. Denzer
- Clinic for Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany
| | - Petros Stathopoulos
- Clinic for Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany
| | - Andreas H. Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Baldingerstrasse, D-35043, Marburg, Germany
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Zhong XQ, Li GX. Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature. World J Clin Cases 2022; 10:3814-3821. [PMID: 35647167 PMCID: PMC9100730 DOI: 10.12998/wjcc.v10.i12.3814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/30/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare but life-threatening cause of upper gastrointestinal bleeding. Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported. The purpose of this study is to report a case of AEF managed by endovascular aortic repair and review the relevant literature.
CASE SUMMARY A 66-year-old man with upper gastroenterology bleeding presented at the Emergency Department of our hospital complaining of chest pain, fever and hematemesis for 6 h. He had vomited 400 mL of bright-red blood and experienced severe chest pain 6 h prior. He had a past medical history of advanced esophageal cancer. He received chemoradiotherapy but stopped 8 mo prior because of intolerance. A chest contrast computed tomographic scan revealed communication between the esophagus and the descending aorta as well as a descending aortic pseudoaneurysm. According to the symptoms and imaging findings, AEF was our primary consideration. The patient underwent aortic angiography, which indicated AEF and descending aortic pseudoaneurysm. Emergency percutaneous thoracic endovascular aortic repair (TEVAR) of the descending aorta was performed, and bleeding was controlled after TEVAR. He received antibiotics and was discharged after treatment. However, he died 2 mo after the TEVAR due to cancer progression.
CONCLUSION Although AEF is a lethal condition, timely diagnosis and TEVAR may successfully control bleeding.
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Affiliation(s)
- Xue-Qing Zhong
- Department of Gastroenterology and Hepatology, Hangzhou Normal University Affiliated Hospital, Hangzhou 310015, Zhejiang Province, China
- Medical College, Hangzhou Normal University, Hangzhou 311121, Zhejiang Province, China
| | - Guo-Xiong Li
- Department of Gastroenterology and Hepatology, Hangzhou Normal University Affiliated Hospital, Hangzhou 310015, Zhejiang Province, China
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Zeng L, Shu W, Ma H, Hu J. Aortic injury caused by esophageal foreign body-case reports of 3 patients and literature review. Medicine (Baltimore) 2020; 99:e20849. [PMID: 32590781 PMCID: PMC7328905 DOI: 10.1097/md.0000000000020849] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Ingestion of a foreign body can cause different degrees of damage to esophagus, and several complications are potentially life-threatening if not properly handled. The aortic injury caused by a perforating esophageal foreign body is rare but lethal. The optimal management still remains controversial. The purpose of this report is to describe our experience in the management of the aortic injury caused by esophageal foreign body ingestion. METHODS Between January 2015 and December 2015, we retrospectively enrolled cases of esophageal perforation involving the aorta by foreign body. The general parameters, esophageal foreign body, types of aortic injury, treatment, and outcome were analyzed. Additionally, we reviewed the literature of the management of esophageal perforation involving the aorta caused by foreign bodies. The study was approved by the ethics committee of the First Affiliated Hospital, College of Medicine, Zhejiang University, and the need for informed consent was waived (Quick review 2019, No. 609). RESULTS Three cases of esophageal perforation involving the aorta by foreign body was selected in the study. Two male and 1 female patients (range, 51-58 years old) with the aorta involvement caused by a perforating foreign body in the esophagus in 3 forms were identified, including 1 patient with mycotic aortic pseudoaneurysm, 1 patient with aortoesophageal fistula and 1 patient with the aortic intramural hematoma. One patient died of the rupture of the pseudoaneurysm during the preparation of the surgery. The other 2 patients were cured with a multidisciplinary approach, which is an urgent thoracic endovascular aortic repair followed by mediastinal debridement/drainage or endoscopic retrieval. Two of 3 patients were survived until now. CONCLUSION The management of the aortic injury caused by esophageal foreign body injury is challenging. Early diagnosis and multidisciplinary management is crucial.
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Successful management of aortoesophageal fistula caused by esophageal cancer using thoracic endovascular aortic repair. Clin J Gastroenterol 2020; 13:678-682. [PMID: 32449088 DOI: 10.1007/s12328-020-01132-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 05/13/2020] [Indexed: 02/08/2023]
Abstract
Aortoesophageal fistula (AEF) is a highly life-threatening condition, even when treated promptly. However, little is known about the treatment for AEF in patients with advanced esophageal cancer. We report the case of a 69-year-old man diagnosed with esophageal squamous cell carcinoma (ESCC) that was admitted to our hospital for ESCC treatment. On diagnosis of unresectable ESCC invading the thoracic aorta, chemotherapy was administered. The response to treatment after two courses was evaluated as stable disease. We performed radiation therapy followed by bypass operation for esophageal stenosis. After radiation therapy, AEF was detected. His condition improved after hemostasis using thoracic endovascular aortic repair (TEVAR). He was discharged from our care after treatment with antibiotics; he died due to cancer progression 7 months after TEVAR. AEF with ESCC is a lethal condition that may occur during cancer treatment; however, TEVAR might help improve the patient's condition.
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Grossman R, Francis R. The Way to Man's Heart Is through the Stomach. Thorac Cardiovasc Surg 2019; 69:2-7. [PMID: 31756748 DOI: 10.1055/s-0039-1700886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Organ systems do not exist in a vacuum. However, in an era of increasingly specialized medicine, the focus is often on the organ system alone. Many symptoms are associated with differential diagnoses from upper gastrointestinal (GI) and cardiovascular medical and surgical specialties. Furthermore, a large number of rare but deadly conditions cross paths between the upper GI tract and cardiovascular system; a significant proportion of these are iatrogenic injuries from a parallel specialty. These include unusual fistulae, herniae, and embolisms that transcend specialties. This review highlights these conditions and the shared anatomy and embryology of the two organ systems.
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Affiliation(s)
- Rebecca Grossman
- Department of General Surgery, Buckinghamshire Healthcare NHS Trust, Amersham, United Kingdom
| | - Rohin Francis
- The Hatter Cardiovascular Institute, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Lee JY, Jang JS, Kim DK, Cha JH, Choi WJ. [Endoscopic Diagnosis of Aortoesophageal Fistula Not Presenting Hematemesis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 73:35-38. [PMID: 30690956 DOI: 10.4166/kjg.2019.73.1.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 05/29/2018] [Accepted: 06/28/2018] [Indexed: 11/03/2022]
Abstract
Aortoesophageal fistula (AEF) is an extremely rare but lethal cause of massive gastrointestinal hemorrhage. Characteristic symptoms are mid-thoracic pain, sentinel minor hemorrhage, and massive hemorrhage after a symptom-free interval. Prompt diagnosis and immediate treatments are necessary to reduce mortality. However, AEF is difficult to diagnose because it is uncommon and often leads to death with massive bleeding before proper evaluation. We report a case of endoscopic diagnosis of AEF that did not present with hematemesis; it was treated with thoracic endovascular aortic repair (TEVAR) and surgery. A 71-year-old female presented to the emergency department with epigastric discomfort. Endoscopy demonstrated a submucosal tumor-like protrusion and pulsating mass with blood clots. Contrast-enhanced chest CT confirmed AEF due to descending thoracic aortic aneurysm. The patient immediately underwent TEVAR to prevent massive bleeding and subsequently underwent surgery. Endoscopists should consider AEF if they see a submucosal tumor-like mass with a central ulcerative lesion or a pulsating protrusion covered with blood clots in mid-esophagus during an endoscopy.
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Affiliation(s)
- Jong Yoon Lee
- Department of Gastroenterology, Dong-A University Hospital, Busan, Korea
| | - Jin Seok Jang
- Department of Gastroenterology, Dong-A University Hospital, Busan, Korea
| | - Dong Kyun Kim
- Department of Gastroenterology, Dong-A University Hospital, Busan, Korea
| | - Jae Hwang Cha
- Department of Gastroenterology, Dong-A University Hospital, Busan, Korea
| | - Won Jong Choi
- Department of Gastroenterology, Dong-A University Hospital, Busan, Korea
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Thoracic Endovascular Aortic Repair of Esophageal Cancer-Associated Aortoesophageal Fistula: A Case Report and Literature Review. Case Rep Oncol Med 2018; 2018:9851397. [PMID: 30662781 PMCID: PMC6313998 DOI: 10.1155/2018/9851397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/26/2018] [Indexed: 12/15/2022] Open
Abstract
Background Thoracic endovascular aortic repair of an aortoesophageal fistula is an effective emergency treatment for patients with T4-esophageal cancer, as it prevents sudden death, and is a bridge to surgery. However, the course of unresectable malignant aortoesophageal fistula treated with thoracic endovascular aortic repair alone is not well-known. Case Presentation We report a 67-year-old Japanese man with T4-esophageal cancer who experienced a chemoradiation-induced aortoesophageal fistula and was rescued with thoracic endovascular aortic repair. He recovered after the procedure and survived for 4 additional months with management of a mycotic aneurysm and secondary aortoesophageal fistula with the exposure of the stent graft into the esophagus. Thoracic endovascular aortic repair of aortoesophageal fistula with T4-esophageal cancer extended life for nearly an average of 4 months in the reported cases. As a postoperative complication, the exposure of the stent graft into the esophagus is rare but life-threatening; the esophageal stent insertion was effective. Conclusions With postoperative management advances, thoracic endovascular aortic repair can improve survival and increase the quality of life of patients with T4-esophageal cancer.
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Wong PC, Chan YC, Law Y, Keung Cheng SW. Emergency aortic stent-graft treatment for malignant aortoesophageal fistula. Asian Cardiovasc Thorac Ann 2017; 25:649-652. [DOI: 10.1177/0218492317741788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Two patients with locally advanced squamous cell carcinoma of the mid-esophagus, with esophageal stents in situ, suffered sudden onset of massive hematemesis and hemodynamic instability due to an aortoesophageal fistula. Although their esophageal neoplasms were deemed inoperable and treatment was palliative, the bleeding was successfully stopped with an endovascular aortic stent-graft. They both remained stable with no septic or hemorrhagic complications, and survived for 14 and 16 weeks after the operation. We emphasize that even if esophageal tumors are locally advanced, emergency endovascular management of aortoesophageal fistula is worthwhile for prolongation of survival.
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Affiliation(s)
- Pak Chiu Wong
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Yiu Che Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Yuk Law
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Stephen Wing Keung Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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Abstract
The potential for intraoperative bleeding is inherent to the practice of thoracic surgery due to the presence of multiple vital vascular structures, complex anatomy, and constant cardiorespiratory motion. Careful and detailed preoperative evaluation and planning, comprehensive review of imaging studies, and a thorough knowledge of the operative procedure, anatomic relationships, and potential complications are of the highest importance in prevention and avoidance of bleeding complications. Preparation with a clear crisis management plan ensures an effective and expedited response when intraoperative bleeding occurs.
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Affiliation(s)
- Manuel Villa
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Inderpal S Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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12
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Canaud L, Ozdemir BA, Bee WW, Bahia S, Holt P, Thompson M. Thoracic endovascular aortic repair in management of aortoesophageal fistulas. J Vasc Surg 2013; 59:248-54. [PMID: 24199764 DOI: 10.1016/j.jvs.2013.07.117] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/29/2013] [Accepted: 07/29/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To provide a systematic review of the outcomes of thoracic endovascular aortic repair (TEVAR) for aortoesophageal fistula (AEF) and to identify prognostic factors associated with poor outcomes. METHODS Literature searches of the Embase, Medline, and Cochrane databases identified relevant articles reporting results of TEVAR for AEF. The main outcome measure was the composite of aortic mortality, recurrence of the AEF, and stent graft explantation. The secondary outcome measure was aortic-related mortality. RESULTS Fifty-five articles were integrated after a literature search identified 72 patients treated by TEVAR for AEFs. The technical success rate of TEVAR was 87.3%. The overall 30-day mortality was 19.4%. Prolonged antibiotics (>4 weeks) were administered in 80% of patients. Concomitant or staged resection or repair of the esophagus was performed in 44.4% of patients. Stent graft explantation was performed within the first month after TEVAR as a planned treatment in 11.1%. After a mean follow-up of 7.4 months (range, 1-33 months), the all-cause mortality was 40.2%, and the aortic-related mortality was 33.3. Prolonged antibiotic treatment (P = .001) and repair of AEFs due to a foreign body (P = .038) were associated with a significant lower aortic mortality. On univariate analysis, TEVAR and concomitant or staged adjunctive procedures (resection, repair of the esophagus, or a planned stent graft explantation) were associated with a significantly lower incidence of aortic-related mortality (P = .0121). When entered into a binary logistic regression analysis, prolonged antibiotic treatment was the only factor associated with a significant lower incidence of the endpoint (P = .003). CONCLUSIONS Late infection or recurrence of the AEF and associated mortality rates are high when TEVAR is used as a sole therapeutic strategy. Prolonged antibiotic treatment has a strong negative association with mortality. A strategy of a temporizing endovascular procedure to stabilize the patient in extremis, and upon recovery, an open surgical esophageal repair with or without stent graft explantation is advocated.
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Affiliation(s)
- Ludovic Canaud
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.
| | - Baris Ata Ozdemir
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
| | - William Wynter Bee
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
| | - Sandeep Bahia
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
| | - Peter Holt
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
| | - Matt Thompson
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
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13
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Ozaki K, Sanada J, Ohtake H, Watanabe G, Matsui O. Successful thoracic endovascular aortic repair of an aortoesophageal fistula. Vascular 2013; 21:97-101. [DOI: 10.1177/1708538113478716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We report three cases of aortoesophageal fistula (AEF), in which the patients remained free from catastrophic bleeding after endovascular stent-grafting. The three patients, who were not candidates for surgical repair because of their poor general condition and prognosis, underwent endovascular stent-grafting following the administration of antibiotics and were successfully managed; hemostasis was maintained for several months until their death. Although we did not find any conclusive evidence to support this strategy, our experiences suggest that endovascular stent-grafting of AEF is useful for maintaining hemodynamic stability.
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Affiliation(s)
- Kumi Ozaki
- Kanazawa University Graduate School of Medical Science – Radiology
| | - Junichiro Sanada
- Kanazawa University Graduate School of Medical Science – Radiology
| | - Hiroshi Ohtake
- Kanazawa University Graduate School of Medical Science – General and Cardiothoracic Surgery, Kanazawa, Ishikawa 920-8641, Japan
| | - Go Watanabe
- Kanazawa University Graduate School of Medical Science – General and Cardiothoracic Surgery, Kanazawa, Ishikawa 920-8641, Japan
| | - Osamu Matsui
- Kanazawa University Graduate School of Medical Science – Radiology
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Aortic fistula after neoadjuvant chemoradiotherapy and esophagectomy for esophageal carcinoma: an unusual cause of sudden death. Am J Forensic Med Pathol 2013; 33:270-2. [PMID: 22854882 DOI: 10.1097/paf.0b013e318252e5e7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Aortic fistula to the enteric tract is an uncommon but recognized complication of esophagectomy, whereas an aortorespiratory fistula is usually described in the setting of aortic disease or previous aortic surgery. We describe 2 cases of fatal aortic fistula occurring after esophagectomy and neoadjuvant chemoradiotherapy, both encountered at autopsy.The first case is an aortobronchial fistula occurring in a 47-year-old male in the early postoperative setting. Death was caused by rupture of the fistula into the posterior mediastinum with transhiatal extension and hemoperitoneum. The tissue adjacent to the fistula showed radiation effect, and an esophageal stent had been placed before surgery. The second case is an aortogastric tube fistula occurring in a 50-year-old male 2 years after surgery and resulting in fatal gastrointestinal hemorrhage. The fistula involved the site of anastomosis and a surgical clip was present in the adjacent soft tissue.The development of aortic fistula after esophagectomy for esophageal carcinoma is rare, but should be considered at autopsy as a potential cause of unexpected, sudden death in these patients. Possible inciting mechanisms in this setting include the presence of foreign material (stent placement and surgical clips) and previous chemoradiation.
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15
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Lee RY, Flaherty L, Khushalani NI, Kanehira K, Nwogu C, Yendamuri S, Nava HR, Yang GY. Aorto-esophageal fistula: a rare fatal case caused by esophageal malignancy. J Gastrointest Oncol 2012; 1:64-5. [PMID: 22811806 DOI: 10.3978/j.issn.2078-6891.2010.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 08/22/2010] [Indexed: 01/19/2023] Open
Affiliation(s)
- Richard Y Lee
- Department of Radiation Medicine, Roswell Park Cancer Institute, New York, USA
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17
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Matono S, Fujita H, Tanaka T, Nagano T, Nishimura K, Murata K, Onitsuka S, Tanaka A, Akashi H, Shirouzu K. Thoracic endovascular aortic repair for aortic complications after esophagectomy for cancer: report of three cases. Dis Esophagus 2011; 24:E36-40. [PMID: 21883655 DOI: 10.1111/j.1442-2050.2011.01234.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aortic complications after esophageal cancer surgery are rare and usually fatal. Here, we report three patients who underwent thoracic endovascular aortic repair (TEVAR) for aortic complications after esophagectomy for cancer. In the first case, aortic rupture was caused by pyothorax due to residual tumor after esophagectomy. In the second case, aortic rupture was caused by pyothorax due to anastomotic leakage. In the third case, a pseudoaneurysm was caused by surgical injury during esophagectomy. TEVAR was safe and effective for severe aortic complications when graft infection was avoided. The first case died of sepsis on the 84th postoperative day, and the other two cases have survived 4 years and 2 years to date.
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Affiliation(s)
- S Matono
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
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18
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Zaporteza K, Anaya-Ayala JE, Davies MG, Peden EK, Lumsden AB. Recurrent collapse of a Gore TAG endograft in treating an aortoesophageal fistula. Vascular 2011; 19:154-8. [DOI: 10.1258/vasc.2010.cr0242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
As the utility of the Gore TAG endograft expands in an off-label fashion to include various aortic pathologies like aortoesophageal fistulas (AEFs), more TAG endograft collapses are being described in the literature. We report a case of a recurrent endograft collapse in a patient with a right-sided aortic arch, who was treated for a hemorrhage from an AEF. One month following the initial endograft placement, angiography detected infolding of the endograft, which was then re-expanded with another endograft. Four months later, the patient developed an acute biventricular dysfunction with an ejection fraction (EF) less than 20%. Cardiac catheterization revealed that the patient had an 80 mmHg pressure gradient across the endograft suggesting another collapse. A balloon-expandable stent was used to re-expand the endografts and restore the EF. On follow-up, the patient's endograft has remained patent without evidence of further collapse.
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Affiliation(s)
- Kris Zaporteza
- Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital Research Institute, 6550 Fannin, Smith Tower, Suite 1401, Houston, TX 77030, USA
| | - Javier E Anaya-Ayala
- Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital Research Institute, 6550 Fannin, Smith Tower, Suite 1401, Houston, TX 77030, USA
| | - Mark G Davies
- Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital Research Institute, 6550 Fannin, Smith Tower, Suite 1401, Houston, TX 77030, USA
| | - Eric K Peden
- Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital Research Institute, 6550 Fannin, Smith Tower, Suite 1401, Houston, TX 77030, USA
| | - Alan B Lumsden
- Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital Research Institute, 6550 Fannin, Smith Tower, Suite 1401, Houston, TX 77030, USA
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19
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Li HP, Hsieh CC, Chiang HH, Wang TH, Lee JY, Huang MF, Chou SH. Aortobronchial fistula after esophagectomy for esophageal cancer -- a very rare complication. Kaohsiung J Med Sci 2011; 27:247-50. [PMID: 21601172 DOI: 10.1016/j.kjms.2010.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 09/16/2010] [Indexed: 12/29/2022] Open
Abstract
Most aorto-respiratory fistulas are related to aortic pathology or procedures, but fistula formation after esophageal resection has never been reported in the literature. We are now reporting a case of hemoptysis that occurred after esophagectomy for locally advanced esophageal cancer. Aortobronchial fistula was detected by computed tomography scan. The patient was finally saved by emergency surgery-Dacron graft interposition of the descending thoracic aorta. There was no malignant cell in the postoperative specimen of the fistula. The erosion of the ligaclips (Johnson & Johnson) might be responsible for the aortobronchial fistula formation. For esophageal surgery, avoidance of trauma to aortic wall and careful using of ligaclips are important to circumvent this complication.
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Affiliation(s)
- Hsien-Pin Li
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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20
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Ghosh SK, Rahman FZ, Bown S, Harris P, Fong K, Langmead L. Survival following Treatment of Aortoesophageal Fistula with Dual Esophageal and Aortic Intervention. Case Rep Gastroenterol 2011; 5:40-4. [PMID: 21326857 PMCID: PMC3037993 DOI: 10.1159/000323700] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aortoesophageal fistulas are a rare but commonly fatal complication of esophageal cancer. Reports of successfully managed cases are few, with high mortality and morbidity usually resulting from failure to control the initial massive haemodynamic insult. We report the case of a 47-year-old Caucasian man with recently diagnosed advanced esophageal cancer who suffered an episode of massive haematemesis. Emergency gastroscopy revealed an arterial bleeding point in the proximal esophagus. A self-expanding metal esophageal stent was placed to achieve initial partial haemostasis. CT angiography confirmed an aortoesophageal fistula. An endoluminal stent device was thus inserted within the thoracic aorta stabilising the bleeding point. The patient subsequently made an uneventful recovery and was discharged on long-term antibiotics for palliative care. He survived for 2 months at home before dying of disseminated malignancy. The successful use of esophageal stenting as a means of achieving haemostasis, allowing time for endovascular intervention, is as yet a relatively unexplored area of management of this rare condition.
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Affiliation(s)
- Soumitra K Ghosh
- Department of Gastroenterology, University College Hospital, London, UK
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21
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Malas MB, Saha S, Qazi U, Duncan M, Perler BA, Freischlag JA, Veith FJ. Is Endovascular Stent-Graft Treatment of Primary Aortoesophageal Fistula Worthwhile? Vasc Endovascular Surg 2010; 45:83-9. [DOI: 10.1177/1538574410380793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aortoesophageal fistula (AEF) as a result of prolonged nasogastric intubation is rare and certainly fatal, without prompt surgical intervention. We report the case of a 41-year-old man with morbid obesity who was admitted after suffering 55% of total body surface area burns. After several skin graft operations over the course of 12 weeks, he was rushed into surgery because of the acute onset of severe upper gastrointestinal bleeding. Exploratory laparotomy and esophagogastroduodenoscopy (EGD) suggested an AEF, which was then quickly confirmed by a diagnostic angiogram. An endovascular aortic stent graft repair was performed that successfully stopped the bleeding. We include a review of the literature pertaining to cases of AEF treated by endovascular surgery, which appears to be a promising alternative to open surgery in the unfit patient.
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Affiliation(s)
- Mahmoud B. Malas
- Department of Surgery, Division of Vascular Surgery, School of Medicine, Johns Hopkins University MD, USA
| | - Surajit Saha
- School of Medicine, Johns Hopkins University MD, USA
| | - Umair Qazi
- Department of Surgery, Division of Vascular Surgery, School of Medicine, Johns Hopkins University MD, USA,
| | - Mark Duncan
- Department of Surgery, Division of Vascular Surgery, School of Medicine, Johns Hopkins University MD, USA
| | - Bruce A. Perler
- Department of Surgery, Division of Vascular Surgery, School of Medicine, Johns Hopkins University MD, USA
| | - Julie A. Freischlag
- Department of Surgery, Division of Vascular Surgery, School of Medicine, Johns Hopkins University MD, USA
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Jonker FHW, Schlösser FJV, Moll FL, van Herwaarden JA, Indes JE, Verhagen HJM, Muhs BE. Outcomes of thoracic endovascular aortic repair for aortobronchial and aortoesophageal fistulas. J Endovasc Ther 2009; 16:428-40. [PMID: 19702348 DOI: 10.1583/09-2741r.1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To identify in-hospital and follow-up outcomes of thoracic endovascular aortic repair (TEVAR) for aortobronchial fistula (ABF) and aortoesophageal fistula (AEF). METHODS The authors reviewed all published cases of ABF and AEF undergoing TEVAR indexed in the MEDLINE, Cochrane Library CENTRAL, and EMBASE databases. After removal of duplicates, 850 articles were scrutinized for relevance and validity. Exclusion criteria included: (1) no clear description of the organs involved with the fistula, (2) no description of outcomes after TEVAR for ABF or AEF, or (3) no original data presented in the article. In this manner, 66 relevant articles were identified that included original data on 114 patients (76 men; mean age 63+/-1.5 years) with ABF (n = 71) or AEF (n = 43). Meta-analyses were performed to investigate outcomes of TEVAR for ABF and AEF. RESULTS Patients with AEF presented more frequently with hypovolemic shock (33% versus 13%, p = 0.012) and systemic infection (36% versus 9%, p<0.001) compared to patients with ABF. In-hospital mortality was 3% (n = 2) after TEVAR for ABF and 19% (n = 8) after TEVAR for AEF (p = 0.004). Additional thoracic surgery in the first 30 days after TEVAR was performed in 3% (n = 2) of ABF patients and in 37% (n = 16) of AEF patients (p<0.001); 12 AEF patients who had received esophageal surgery in the first month after TEVAR showed lower fistula-related mortality during 6 months of follow-up compared to patients who did not receive additional esophageal surgery (p = 0.018). CONCLUSION TEVAR is associated with superior outcomes in patients with ABF. Endovascular management of AEF is associated with poor results and should not be considered definitive treatment. TEVAR could serve as a bridge to surgery for emergency cases of AEF only, with definitive open surgical correction of the fistula undertaken as soon as possible.
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Affiliation(s)
- Frederik H W Jonker
- Department of Surgery and Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
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Jonker FHW, Heijmen R, Trimarchi S, Verhagen HJM, Moll FL, Muhs BE. Acute management of aortobronchial and aortoesophageal fistulas using thoracic endovascular aortic repair. J Vasc Surg 2009; 50:999-1004. [PMID: 19481408 DOI: 10.1016/j.jvs.2009.04.043] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 04/10/2009] [Accepted: 04/17/2009] [Indexed: 11/16/2022]
Affiliation(s)
- Frederik H W Jonker
- Section of Vascular Surgery, Department of Surgery at Yale University School of Medicine, New Haven, CT 06510, USA
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24
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Takano S, Katsuhara K, Nobuhara K, Ueda S, Imura M, Hohjo Y. Aortoesophageal fistula due to esophageal ulcer. Gen Thorac Cardiovasc Surg 2009; 57:255-7. [DOI: 10.1007/s11748-008-0378-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Accepted: 11/19/2008] [Indexed: 11/29/2022]
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Outcome after endovascular stent graft repair of aortoenteric fistula: A systematic review. J Vasc Surg 2008; 49:782-9. [PMID: 19028054 DOI: 10.1016/j.jvs.2008.08.068] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 08/04/2008] [Accepted: 08/26/2008] [Indexed: 12/25/2022]
Abstract
BACKGROUND Aortoenteric fistula (AEF) is a critical clinical condition, which may present with gastrointestinal hemorrhage, with or without signs of sepsis. Conventional open surgical repair is associated with high morbidity and mortality. Endovascular stent graft repair has been attempted, but recurrent infection remains of major concern. We conducted a systematic review to assess potential factors associated with poor outcome after endovascular treatment. METHODS The English literature was searched using the MEDLINE electronic database up to April 2008. All studies reporting on the primary management of primary or secondary AEF with endovascular stent graft repair were considered. RESULTS Data were extracted from 33 reports that included 41 patients and were entered in the final analysis. Persistent/recurrent/new infection or recurrent hemorrhage developed in 44% of the patients, after a mean follow-up period of 13 months (range, 0.13-36). Secondary, as compared to primary, AEF had an almost threefold increased risk of persistent/recurrent infection. Evidence of sepsis preoperatively was found to be a factor indicating unfavorable outcome (P < .05). Persistent/recurrent/new infection after treatment was associated with worse 30-day and overall survival compared with those who did not develop sepsis (P < .05). CONCLUSION Endovascular stent graft repair of AEF was associated with a high incidence of infection or recurrent bleeding postoperatively. Evidence of sepsis preoperatively was indicating poor outcome.
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Kische S, Akin I, Ince H, Rehders TC, Schneider H, Ortak J, Nienaber CA. Reparación mediante implantación de stents en enfermedades agudas y crónicas de la aorta torácica. Rev Esp Cardiol 2008. [DOI: 10.1157/13126047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Lozano FS, Muñoz-Bellvis L, San Norberto E, Garcia-Plaza A, Gonzalez-Porras JR. Primary aortoduodenal fistula: new case reports and a review of the literature. J Gastrointest Surg 2008; 12:1561-5. [PMID: 18301952 DOI: 10.1007/s11605-008-0499-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 02/05/2008] [Indexed: 01/31/2023]
Affiliation(s)
- Francisco S Lozano
- Angiology and Vascular Surgery, University Hospital of Salamanca, Paseo de San Vicente, 58-182, Salamanca, 37007, Spain.
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28
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NISHIMURA K, TANAKA T, TANAKA Y, ONITSUKA S, SHIROUZU K, FUJITA H. ENDOVASCULAR ANEURYSM REPAIR FOR A RUPTURE IN THE AORTA AFTER ESOPHAGECTOMY-A CASE REPORT-. ACTA ACUST UNITED AC 2008. [DOI: 10.3919/jjsa.69.2818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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29
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Kische S, Rehders TC, Akin I, Ince H, Nienaber CA. Role of interventional repair in the thoracic aorta. Future Cardiol 2007; 3:399-412. [PMID: 19804231 DOI: 10.2217/14796678.3.4.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Endovascular treatment of chronic aneurysmatic diseases of the descending thoracic aorta has demonstrated encouraging peri-interventional mortality and morbidity and is accepted as a preferred strategy in experienced centers. The emergence of endovascular strategies for acute thoracic aortic pathologies is an even more exciting new territory for nonsurgical interventions considering the sobering results of open surgery. Although it is apparent that patients at high risk for open surgery will benefit from endovascular strategies, the exact role of stent-graft placement remains to be defined, as the community awaits solid long-term data and as devices and techniques continue to improve. While some indications and scenarios, such as acute type B dissection with associated malperfusion syndrome or imminent aortic rupture, have been shown to benefit from stent-graft treatment, others are less settled. The current paper discusses both the established and emerging indications, as well as technical and anatomical aspects of this fascinating therapeutic option.
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Affiliation(s)
- Stephan Kische
- Rostock School of Medicine, Division of Cardiology at the University Hospital Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany.
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30
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Golledge J, Liffman K, Lawrence-Brown MMD. Thoracic stent graft design improvements with dynamic CT angiography. Eur J Vasc Endovasc Surg 2006; 33:69-70. [PMID: 17067827 DOI: 10.1016/j.ejvs.2006.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2006] [Accepted: 09/05/2006] [Indexed: 10/24/2022]
Affiliation(s)
- J Golledge
- Vascular Biology Unit, School of Medicine, James Cook University, Townsville, Australia.
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