1
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Pagano KM, Fokin AA, Parra M, Puente I. Stop exsanguination by inflation: management of aorta-esophageal fistula bleeding. J Surg Case Rep 2024; 2024:rjae120. [PMID: 38463737 PMCID: PMC10924743 DOI: 10.1093/jscr/rjae120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Aortoesophageal fistula is rare and typically presents itself to the emergency department as Chiari's Triad of mid-thoracic pain, sentinel arterial hemorrhage, and exsanguination after a symptom-free interval. However, fatal bleeding may be the first and last presentation of an aortoesophageal fistula. When a patient experiences massive hematemesis without witnesses, EMS may assume that bleed is of a traumatic mechanism. We present a case of a 59-year-old male with no previous medical history who was transported to a trauma center unconscious and with massive bleeding of unknown origin. Computed tomography revealed a thoracic aortic aneurysm and an aortoesophageal fistula. Bleeding was not controlled and the patient expired. Trauma bay personnel should follow an algorithm which includes a prompt tamponade of the bleed using a Sengstaken-Blakemore tube or esophageal balloon paralleled by massive transfusion and obtaining an early computed tomography scan to manage patients with massive gastroesophageal bleeding until appropriate surgical interventions can be initiated.
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Affiliation(s)
- Kristina M Pagano
- Department of Surgery, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St AHC2, Miami, FL 33199, United States
| | - Alexander A Fokin
- Department of Trauma and Acute Care Surgery, Delray Medical Center, 5352 Linton Blvd, Delray Beach, FL 33484, United States
| | - Michael Parra
- Department of Trauma and Acute Care Surgery, Broward County Health Care System, 1800 NW 49th Street, STE. 110, Fort Lauderdale, FL 33309, United States
| | - Ivan Puente
- Department of Trauma and Acute Care Surgery, Broward County Health Care System, 1800 NW 49th Street, STE. 110, Fort Lauderdale, FL 33309, United States
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2
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Hirayu N, Fukuda M, Nabeta M, Takasu O. Aberrant Right Subclavian Artery Complicated by Acquired Hemophilia A and a Subclavian Artery-Esophageal Fistula after Traumatic Injury. J Emerg Trauma Shock 2023; 16:182-184. [PMID: 38292277 PMCID: PMC10824208 DOI: 10.4103/jets.jets_22_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 02/01/2024] Open
Abstract
An aberrant right subclavian artery (ARSA) is a rare developmental anomaly wherein the right subclavian artery arises from the descending aorta as a fourth branch of the aortic arch. We present the case of ARSA in an 81-year-old woman who was injured in a motorcycle accident. The patient had a history of asymptomatic cerebral infarction, type 2 diabetes mellitus, and rheumatoid arthritis. She was diagnosed with spleen and liver injury, left renal injury, along with fractures in the rib, pelvic, vertebrae, and right tibia. On the 3rd hospitalization day, activated partial thromboplastin time (APTT) prolongation was observed, followed by sudden massive hematemesis and shock on the 39th day. We indicate sudden hematemesis and ARSA bleeding as the cause. We performed compression with a Sengstaken-Blakemore tube and coil embolization for hemostasis. Our findings show that the bleeding was mainly caused by nasogastric tube compression, prolonged APTT, and acquired hemophilia A.
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Affiliation(s)
- Nobuhisa Hirayu
- Advanced Emergency and Critical Care Center, Kurume University Hospital, Kurume, Fukuoka, Japan
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Masafumi Fukuda
- Advanced Emergency and Critical Care Center, Kurume University Hospital, Kurume, Fukuoka, Japan
| | - Masakazu Nabeta
- Advanced Emergency and Critical Care Center, Kurume University Hospital, Kurume, Fukuoka, Japan
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Osamu Takasu
- Advanced Emergency and Critical Care Center, Kurume University Hospital, Kurume, Fukuoka, Japan
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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3
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Brotherton T, Numan L, Al-Kaade S. Timely Endoscopic Recognition of Aortoesophageal Fistula With Successful Treatment. ACG Case Rep J 2023; 10:e01123. [PMID: 37547481 PMCID: PMC10402988 DOI: 10.14309/crj.0000000000001123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Aortoesophageal fistula (AEF) is a devastating cause of upper gastrointestinal bleeding that occurs because of pathologic communication of the esophagus with the aorta. Bleeding AEF has high mortality even with appropriate interventions. In this study, we present a case of a 52-year-old man who presented with hematemesis, which was found to be due to an actively bleeding AEF. Prompt identification of the fistula led to multiple endoscopic interventions that stabilized the patient and allowed him to undergo emergent endovascular aortic stent placement with successful bleeding control.
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Affiliation(s)
- Tim Brotherton
- Department of Internal Medicine, Saint Louis University, Saint Louis, MO
| | - Laith Numan
- Department of Gastroenterology and Hepatology, Saint Louis University, Saint Louis, MO
| | - Samer Al-Kaade
- Department of Gastroenterology, Mercy Hospital South, Saint Louis, MO
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4
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Subramanian PC, Chidanandaswamy N, Soundararajan R, Bhujade H, Prabhakar N. An Aberrant Right Subclavian Artery-Esophageal Fistula-A Fatal Complication of a Common Anomaly: A Case Report and Review of Literature. Indian J Radiol Imaging 2022; 33:117-120. [PMID: 36855716 PMCID: PMC9968551 DOI: 10.1055/s-0042-1758194] [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] [Indexed: 11/27/2022] Open
Abstract
An aberrant right subclavian artery (ARSA), also called as arteria lusoria, is one of the most common aortic arch anomalies. ARSA-esophageal fistula is a rare, life-threatening complication, with only 37 cases reported in literature. We describe a case of a young girl who developed acute episode of massive hematemesis after the recovery from novel coronavirus disease 2019 (COVID-19) pneumonia. Computed tomography (CT) angiography showed ARSA with retroesophageal course and active contrast leak in esophagus. Digital subtraction angiography confirmed the site of active contrast extravasation from the ARSA. However, the patient succumbed to hypovolemic shock even before the endovascular or surgical interventions could be done.
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Affiliation(s)
- Pavithra C. Subramanian
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Chidanandaswamy
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raghuraman Soundararajan
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence Harish Bhujade, MD, FVIR Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and ResearchChandigarh 160012India
| | - Nidhi Prabhakar
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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5
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Upper Gastrointestinal Bleeding From Aberrant Right Subclavian Artery-Esophageal Fistula. Ochsner J 2022; 21:406-412. [PMID: 34984057 PMCID: PMC8675615 DOI: 10.31486/toj.20.0142] [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] [Indexed: 11/08/2022] Open
Abstract
Background: The most common aortic arch abnormality is an aberrant right subclavian artery (ARSA). ARSA-esophageal fistula is a rare sequela that can present with a life-threatening upper gastrointestinal (GI) bleed. Case Report: We report the case of an 88-year-old male who presented with signs of upper GI bleeding. Esophagogastroduodenoscopy demonstrated extrinsic compression of the upper third of the esophagus with ulceration. Imaging studies revealed ARSA posterior to the esophagus with pseudoaneurysm formation. These findings confirmed an upper GI bleed secondary to ARSA-esophageal fistula. The patient underwent prompt embolization of the ARSA pseudoaneurysm, followed a few days later by coil embolization of the ARSA pseudoaneurysm. Despite these interventions, the patient continued to have bleeding with anemia. He and his family opted to avoid any further interventions and instead pursued comfort care. The patient was discharged to hospice and died 3 months later. Conclusion: ARSA-esophageal fistula is a rare but potentially lethal cause of upper GI bleeding. Initial signs and symptoms can be subtle, but the presence of a GI bleed requires immediate stabilization. Surgical interventions have been shown to have longer-lasting success, but endovascular repair may be an option for patients who are deemed unfit for surgery but still require prompt stabilization. Regardless of the intervention, mortality rates for ARSA-esophageal fistula are high.
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6
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Kim S, Jeon KN, Bae K. Aberrant Left Subclavian Artery-Esophageal Fistula in a Patient with a Prolonged Use of Nasogastric Tube: A Case Report and Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11020195. [PMID: 33525727 PMCID: PMC7911238 DOI: 10.3390/diagnostics11020195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 01/06/2023] Open
Abstract
Arterial-esophageal fistula is a rare but potentially fatal complication. Right aortic arch with aberrant left subclavian artery is a rare congenital vascular anomaly that can cause esophageal compression, particularly when the proximal portion of the aberrant subclavian artery forms a Kommerell's diverticulum. Prolonged use of a nasogastric tube can cause pressure necrosis of the esophagus. We report a patient with massive gastrointestinal bleeding secondary to aberrant left subclavian artery-esophageal fistula after a prolonged use of nasogastric tube. A high index of suspicion is essential for better prognosis when a patient with congenital aortic arch anomaly shows upper gastrointestinal hemorrhage.
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Affiliation(s)
- Sungbin Kim
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea; (S.K.); (K.B.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
| | - Kyung Nyeo Jeon
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea; (S.K.); (K.B.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
- Correspondence: ; Tel.: +82-55-214-3896
| | - Kyungsoo Bae
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea; (S.K.); (K.B.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
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7
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Popova IE, Danielian SN, Pogodina AN, Chernaia NR, Muslimov RS, Mironov AV, Kokov LS. [Peculiarities of diagnosis and emergency surgical care in aorto-oesophageal fistula]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:108-114. [PMID: 33063757 DOI: 10.33529/angiq2020303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An aorto-oesophageal fistula is a rare but life-threatening pathological condition developing on the background of diseases of the aorta and oesophagus, as well as after surgical interventions on the aorta. The article deals with a clinical case report regarding management of a patient presenting with an aorto-oesophageal fistula resulting from a thoracic artery aneurysm. The main clinical manifestations of the diseases included dysphagia (due to oesophageal obstruction caused by thrombotic masses of the aneurysm) and the occurring gastrointestinal haemorrhage. Comprehensive instrumental diagnosis was performed using roentgen examination of the oesophagus, oesophagoscopy, and contrast-enhanced computed tomography of the chest. The obtained findings made it possible to objectively assess the patient's state, to carry out timely treatment in conditions of a surgical hospital, and to avoid severe complications.
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Affiliation(s)
- I E Popova
- Department of Radiodiagnosis, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - Sh N Danielian
- Department of Thoracoabdominal Surgery, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - A N Pogodina
- Department of Thoracoabdominal Surgery, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - N R Chernaia
- Department of Radiodiagnosis, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - R Sh Muslimov
- Department of Radiodiagnosis, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - A V Mironov
- Department of Emergency Surgery, Endoscopy and Intensive Therapy, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - L S Kokov
- Department of Radiodiagnosis, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia; Department of Radiodiagnosis of the Institute of Professional Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
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8
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Choi Y, Chung SB, Kim MS. Prevalence and Anatomy of Aberrant Right Subclavian Artery Evaluated by Computed Tomographic Angiography at a Single Institution in Korea. J Korean Neurosurg Soc 2019; 62:175-182. [PMID: 30840972 PMCID: PMC6411572 DOI: 10.3340/jkns.2018.0048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/30/2018] [Indexed: 12/14/2022] Open
Abstract
Objective Aberrant right subclavian artery (ARSA) is a rare anatomical variant of the origin of the right subclavian artery. ARSA is defined as the right subclavian artery originating as the final branch of the aortic arch. The purpose of this study is to determine the prevalence and the anatomy of ARSA evaluated with computed tomography (CT) angiography.
Methods CT angiography was performed in 3460 patients between March 1, 2014 and November 30, 2015 and the results were analyzed. The origin of the ARSA, course of the vessel, possible inadvertent ARSA puncture site during subclavian vein catheterization, Kommerell diverticula, and associated vascular anomalies were evaluated. We used the literature to review the clinical importance of ARSA.
Results Seventeen in 3460 patients had ARSA. All ARSAs in 17 patients originated from the posterior aspect of the aortic arch and traveled along a retroesophageal course to the right thoracic outlet. All 17 ARSAs were located in the anterior portion from first to fourth thoracic vertebral bodies and were located near the right subclavian vein at the medial third of the clavicle. Only one of 17 patients presented with dysphagia.
Conclusion It is important to be aware ARSA before surgical approaches to upper thoracic vertebrae in order to avoid complications and effect proper treatment. In patients with a known ARSA, a right transradial approach for aortography or cerebral angiography should be changed to a left radial artery or transfemoral approach.
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Affiliation(s)
- Yunsuk Choi
- Department of Neurosurgery, National Medical Center, Seoul, Korea
| | - Sang Bong Chung
- Department of Neurosurgery, National Medical Center, Seoul, Korea
| | - Myoung Soo Kim
- Department of Neurosurgery, National Medical Center, Seoul, Korea.,Brain Center, Pohang SM Christianity Hospital, Pohang, Korea
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9
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Anomalous Right Subclavian Artery-Esophageal Fistulae. Case Rep Vasc Med 2018; 2018:7541904. [PMID: 29686924 PMCID: PMC5852896 DOI: 10.1155/2018/7541904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/01/2018] [Indexed: 01/27/2023] Open
Abstract
An aberrant right subclavian artery (ARSA) is the most common aortic arch anomaly, but only 19 previous cases of ARSA-esophageal fistula have been reported. Six patients have survived their bleeding episode. We describe the case of a 44-year-old woman who developed massive hemoptysis. Laryngoscopy, bronchoscopy, head and neck angiogram, and median sternotomy did not reveal what was presumed initially to be a tracheoinnominate fistula. Contrasted CT showed an anomalous subclavian artery posterior to the esophagus. Given the technical challenge of approaches for this pathology, the patient was unfit for open surgical repair. Therefore, endovascular covered stent grafts were deployed spanning the segment of the subclavian artery in continuity with the esophagus, via a right brachial artery approach. Unfortunately, the patient died after successful placement of the grafts.
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10
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Uno K, Koike T, Takahashi S, Komazawa D, Shimosegawa T. Management of aorto-esophageal fistula secondary after thoracic endovascular aortic repair: a review of literature. Clin J Gastroenterol 2017; 10:393-402. [PMID: 28766283 DOI: 10.1007/s12328-017-0762-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 07/06/2017] [Indexed: 12/15/2022]
Abstract
Aorto-esophageal fistula (AEF) is a rare and lethal entity, and the difficulty of making diagnosis of AEF is well-known. As promising results in the short-term effectiveness of thoracic endovascular aortic repair (TEVAR) promote its usage, the occurrence of AEF after TEVAR (post-TEVAR AEF) increases as one of the major complications. Therefore, we provide a review concerning the management strategy of post-TEVAR AEF. Although its representative symptom was reported as the triad of mid-thoracic pain and sentinel hematemesis followed by massive hematemesis, the symptom-free interval between sentinel hemorrhage and massive exsanguination is unpredictable. However, the physiological condition represents a surgical contraindication. Accordingly, early diagnosis is important, but either CT or esophago-gastro-duodenoscopy rarely depicts a typical image. The formation of post-TEVAR AEF might be associated with the infection of micro-organisms, which is uncontrollable with anti-biotic administration. The current first-line strategy is combination therapy as follows, (1) to control bleeding by TEVAR in the urgent phase, and (2) radical debridement and aortic/esophageal re-construction in the semi-urgent phase. In view of the high mortality and morbidity rate, it is proposed that the choice in treatment strategies might be affected by patient`s condition, size of the wall defects and the etiology of AEF. Practically, we should keep in mind the importance of making an early diagnosis and, once a suspicious symptom has occurred in a patient with a history of TEVAR, the existence of post-TEVAR AEF should be suspected. A prospective registry together with more developed technologies will be needed to establish a future strategy.
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Affiliation(s)
- Kaname Uno
- Division of Gastroenterology, Tohoku University Hospital, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 981-8574, Japan. .,Department of Gastrointestinal and Community Medicine, Tohoku University, 16 Kuzehara Uchigo-mimaya cho, Iwaki, Fukushima, 973-8555, Japan.
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Hospital, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 981-8574, Japan
| | - Seiichi Takahashi
- Department of Gastrointestinal and Community Medicine, Tohoku University, 16 Kuzehara Uchigo-mimaya cho, Iwaki, Fukushima, 973-8555, Japan
| | - Daisuke Komazawa
- Department of Gastrointestinal and Community Medicine, Tohoku University, 16 Kuzehara Uchigo-mimaya cho, Iwaki, Fukushima, 973-8555, Japan
| | - Tooru Shimosegawa
- Division of Gastroenterology, Tohoku University Hospital, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 981-8574, Japan
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11
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Kudose S, Pineda J, Saito JM, Dehner LP. Aberrant Right Subclavian Artery-Esophageal Fistula in 20-Year-Old with VATER Association. J Pediatr Intensive Care 2017; 6:127-131. [PMID: 31073436 DOI: 10.1055/s-0036-1584812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/02/2016] [Indexed: 10/21/2022] Open
Abstract
Aberrant right subclavian artery (ARSA), the most common aortic arch abnormality, occurs in approximately 0.5 to 1.8% of the general population, with prevalence of up to 25% in those with esophageal atresia. Although ARSA is often asymptomatic, a fistulous tract into esophagus may develop with prolonged nasogastric tube placement or endotracheal intubation and lead to potentially fatal hematemesis. We present a first case of ARSA-esophageal fistula in a 20-year-old woman with VATER association in the absence of an esophageal anomaly and review 28 cases of ARSA-esophageal fistula reported in the literature to date. Requiring nasogastric and endotracheal tube placement for approximately 4 months, the patient had a prolonged hospital course and died after sudden hematemesis. An autopsy demonstrated an ARSA-esophageal fistula and no other source of upper gastrointestinal bleeding. In patients with esophageal atresia requiring prolonged placement of an endotracheal or nasogastric tube, a screening imaging study and corrective surgery may be indicated. Although the mortality rate is still high, timely recognition and repair of ARSA-esophageal fistula appear to be improving. Given the potentially prolonged latency for its development with occasional presence of heralding symptoms, increased awareness may facilitate surgical intervention to prevent a catastrophic exsanguination.
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Affiliation(s)
- Satoru Kudose
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Jose Pineda
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Jacqueline M Saito
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Louis P Dehner
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, United States
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12
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Epstein DA, Debord JR. Abnormalities Associated with Aberrant Right Subclavian Arteries. Vasc Endovascular Surg 2016; 36:297-303. [PMID: 15599481 DOI: 10.1177/153857440203600408] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An aberrant right subclavian artery (ARSA) is an anomaly with a reported incidence of 0.5% to 2%. Usually the aberrant artery follows a retroesophageal course; rarely it takes a course anterior to the esophagus or the trachea. Most patients with an ARSA remain asymptomatic; however, progressive dysphagia develops occasionally. The choice of approach depends on the presence or absence of aneurysmal disease, the urgency of the operation, and the surgeon's experience. A case is reported of a 33-year-old white male patient who had a 3-year history of progressive dysphagia to the point that he was only able to swallow liquids. A barium swallow demonstrated a posterior extrinsic compression of the esophagus. Angiography was performed, which demonstrated an ARSA with a common origin of the right and left common carotid arteries. Surgical correction was performed via a right supraclavicular neck incision. The proximal aberrant artery was mobilized behind the esophagus. The distal, right subclavian artery was exposed, transected, and transposed with reimplantation into the right common carotid artery. An aberrant right thoracic duct was encountered and ligated. The English language literature from 1960 to present was reviewed via a Medline search. Reported anomalies associated with ARSAs include a nonrecurrent right inferior laryngeal nerve, a common origin of the common carotid arteries, a replaced right or left vertebral artery, coarctation of the aorta, a right-sided thoracic duct, and a right-sided aortic arch. It is important to be aware of these associated anomalies and how they impact the operative approach involved in the correction of dysphagia lusoria.
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Affiliation(s)
- David A Epstein
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
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13
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Lin CS, Lin CW. Left subclavian artery-esophageal fistula induced by a paper star: a case report. Biomedicine (Taipei) 2016; 6:18. [PMID: 27514535 PMCID: PMC4980826 DOI: 10.7603/s40681-016-0018-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 05/06/2016] [Indexed: 11/06/2022] Open
Abstract
A subclavian artery-esophageal fistula usually occurs on the right side of an
aberrant subclavian artery. It also rarely appears in the site between a
non-aberrant subclavian artery and the esophagus due to the ingestion of a foreign
body. Upper gastrointestinal bleeding in the case of a subclavian artery-esophageal
fistula is rare but often fatal. Here, we report on a 62-year-old male patient with
a left subclavian arteryesophageal fistula complicated by hemorrhagic shock. He
swallowed a foreign body at a birthday party. An upper gastrointestinal endoscopy
indicated a paper star lodged at 20 cm from the incisors, inducing a kissing
esophageal ulcer around the esophageal sphincter. One month later, he suffered an
unusually strong episode of hematemesis. Subsequently, a computed tomography
angiography was performed and demonstrated a left subclavian artery-esophageal
fistula. Finally, the fistula induced by the ingestion of a paper star was
successfully treated by endovascular stent grafting.
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Affiliation(s)
- Chen-Sheng Lin
- Division of Gastroenterology, Kuang Tien General Hospital, 433, Taichung, Taiwan
| | - Cheng-Wen Lin
- Department of Medical Laboratory Science and Biotechnology, China Medical University, No. 91, Hsueh-Shih Road, 404, Taichung, Taiwan. .,Department of Biotechnology, Asia University, 413, Wufeng, Taichung, Taiwan.
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14
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Oliveira E, Anastácio M, Marques A. Fístula de artéria subclávia direita anômala com esôfago – hemorragia digestiva alta maciça secundária a intubação gástrica prolongada. Rev Bras Anestesiol 2016. [DOI: 10.1016/j.bjan.2013.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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15
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Oliveira E, Anastácio M, Marques A. Aberrant right subclavian artery-esophageal fistula: massive upper gastrointestinal hemorrhage secondary to prolonged intubation. Braz J Anesthesiol 2016; 66:318-20. [PMID: 27108831 DOI: 10.1016/j.bjane.2013.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 07/16/2013] [Accepted: 07/25/2013] [Indexed: 01/20/2023] Open
Abstract
Aberrant right subclavian artery-esophageal fistula is a rare but potentially fatal complication. It may be associated with procedures, such as tracheostomy and tracheal or esophageal intubation, and yields massive upper gastrointestinal bleeding difficult to identify and to control. A high index of suspicion is essential for early diagnosis and better prognosis. We report a rare case of a patient who survived after emergent surgical procedure for massive upper gastrointestinal bleeding secondary to aberrant right subclavian artery-esophageal fistula after prolonged intubation.
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Affiliation(s)
- Elsa Oliveira
- Department of Anesthesiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Margarida Anastácio
- Department of Anesthesiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Anabela Marques
- Department of Anesthesiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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16
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Abstract
An aberrant right subclavian artery arising from a left aortic arch is the most frequently described congenital aortic arch anomaly, occurring in 0.5 to 2.3% of the general population. Despite the retro-oesophageal course of the aberrant subclavian artery, an arterio-oesophageal fistula is an uncommon finding, only previously reported as a very rare complication in critically ill patients with oesophageal instrumentation or foreign body ingestion. We describe a unique case of a spontaneous aberrant right subclavian arterio-oesophageal fistula without an inciting event in a 17-month-child.
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17
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Watanabe M, Suzuki K, Fujinaga K, Yamamoto A, Fujioka M, Katayama N, Imai H. Postmortem diagnosis of massive gastrointestinal bleeding in a patient with aberrant right subclavian artery-esophageal fistula. Acute Med Surg 2015; 3:139-142. [PMID: 29123767 DOI: 10.1002/ams2.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/24/2015] [Indexed: 11/10/2022] Open
Abstract
Case Aberrant right subclavian artery-esophageal fistula is a rare, but fatal, complication. A 55-year-old febrile man with a nasogastric feeding tube developed sudden massive hematemesis and shock. Outcome Upper endoscopy revealed an intragastric hematoma with no active bleeding observed except for oozing from an esophageal tear. Enhanced computed tomography scan detected aberrant right subclavian artery but was unable to determine the bleeding source. Repeat endoscopy carried out on day 2 confirmed hemostasis and the disappearance of the intragastric hematoma. However, the patient suddenly developed recurrent massive hematemesis with refractory shock on day 4 and died. Postmortem computed tomography revealed endoscopic clips in contiguity with aberrant right subclavian artery; a final diagnosis of aberrant right subclavian artery-esophageal fistula was made. Conclusion Our case demonstrates aberrant right subclavian artery-esophageal fistula may present with transient spontaneous hematemesis in a state of shock, possibly related to fever of unknown origin, and is challenging to diagnose by repeated endoscopy once hematemesis develops.
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Affiliation(s)
- Maiko Watanabe
- The Emergency and Critical Care Center Mie University Hospital Tsu Mie Japan
| | - Kei Suzuki
- The Emergency and Critical Care Center Mie University Hospital Tsu Mie Japan.,Department of Hematology and Oncology Mie University Graduate School of Medicine Tsu Mie Japan
| | - Kazuhisa Fujinaga
- The Emergency and Critical Care Center Mie University Hospital Tsu Mie Japan
| | - Akitaka Yamamoto
- The Emergency and Critical Care Center Mie University Hospital Tsu Mie Japan
| | - Masaki Fujioka
- The Emergency and Critical Care Center Mie University Hospital Tsu Mie Japan
| | - Naoyuki Katayama
- Department of Hematology and Oncology Mie University Graduate School of Medicine Tsu Mie Japan
| | - Hiroshi Imai
- The Emergency and Critical Care Center Mie University Hospital Tsu Mie Japan
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18
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Subasinghe D, Sudasinghe H, Keppetiyagama CT, Handagala SD, Abayadeera A, De Zoysa MI. Minithoracotomy oesophagectomy for oesophageal carcinoma with aberrant right subclavian artery: a rare case of dysphagia. BMC Gastroenterol 2014; 14:163. [PMID: 25241171 PMCID: PMC4177690 DOI: 10.1186/1471-230x-14-163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 09/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aberrant R/subclavian artery is a rare congenital anomaly involving aortic arch. Oesophageal carcinoma with associated aberrant R/subclavian artery is very rare and only few cases has been reported in literature. If unrecognized and injured during oesophageal surgery, it can lead to disastrous complications. When associated with oesophageal carcinoma, it can cause diagnostic confusion as the symptoms are similar. CASE PRESENTATION A 60 year old previously healthy female presented with intermittent dysphagia, odynophagia and loss of weight of 3 months duration. She was found to have a oesophageal carcinoma with incidentally co-existing aberrant R/subclavian artery. CONCLUSION Although rare this entity should be considered as a differential diagnosis in a patient with dysphagia. In addition, pre-operative identification is important to prevent intra operative vascular complications. The diagnosis and treatment of this rare condition is discussed in this article.
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Affiliation(s)
- Duminda Subasinghe
- University Surgical Unit, The National Hospital of Sri Lanka, Colombo, Sri Lanka.
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19
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Tanaka H, Kaneko Y, Arai K, Ishihama H, Akiyama S, Muguruma T, Kanamori Y. Successful management of massive bleeding due to aberrant right subclavian artery-esophageal fistula in a child with head injury. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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20
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Hosn MA, Haddad F, El-Merhi F, Safadi B, Hallal A. Repair of an aberrant subclavian arterioesophageal fistula following esophageal stent placement. World J Gastrointest Surg 2014; 6:117-121. [PMID: 24976906 PMCID: PMC4073223 DOI: 10.4240/wjgs.v6.i6.117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/02/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
A fistula formation between the esophagus and an aberrant right subclavian artery is a rare but fatal complication that has been mostly described in the setting of prolonged nasogastric intubation and foreign body erosion. We report a case of a young morbidly obese patient who underwent sleeve gastrectomy that was complicated by a postoperative leak at the level of the gastroesophageal junction. A covered esophageal stent was placed endoscopically to treat the leak. The patient developed massive upper gastrointestinal bleeding secondary to the erosion of the stent into an aberrant retroesophageal right subclavian artery twelve days after stent placement. She was ultimately treated by endovascular stenting of the aberrant right subclavian artery followed by thoracotomy and esophageal repair over a T-tube. This case report highlights the multidisciplinary approach needed to diagnose and manage such a devastating complication. It also emphasizes the need for imaging studies prior to stent deployment to delineate the vascular anatomy and rule out the possibility of such an anomaly in view of the growing popularity of esophageal stents, especially in the setting of a leak.
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21
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Endovascular treatment of a left subclavian pseudoaneurysm induced by ingestion of a foreign body. Ann Vasc Surg 2013; 27:672.e7-11. [PMID: 23809936 DOI: 10.1016/j.avsg.2012.07.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 07/10/2012] [Accepted: 07/28/2012] [Indexed: 12/15/2022]
Abstract
Subclavian artery-esophageal fistula is a life-threatening entity. It usually occurs in cases of an aberrant right subclavian artery. A fistula between a non-aberrant subclavian artery and esophagus is extremely rare and difficult to diagnose. It is generally due to ingestion of a foreign body and it is often lethal. We present a case of subclavian artery-esophageal fistula complicated by mediastinitis in a 45-year-old man. The fistula, induced by ingestion of a fish bone, was successfully treated by endovascular stent grafting and left thoracotomy.
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22
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Takahashi S, Okada K, Orihashi K, Sueda T. Arterio-oesophageal fistula caused by aberrant right subclavian artery aneurysm. Interact Cardiovasc Thorac Surg 2013; 16:920-2. [PMID: 23470613 DOI: 10.1093/icvts/ivt083] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 63-year old man had dysphagia for 4 months and was admitted to our hospital with sudden haematemesis. Computed tomography revealed an aberrant right subclavian artery (ARSA) aneurysm and free air inside the aneurysm. Arterio-oesophageal fistula was diagnosed, and an emergency operation was performed. Before thoracotomy, a percutaneous transluminal angioplasty (PTA) balloon was inserted from the right brachial artery and placed at the orifice of the ARSA to control bleeding. Through a left thoracotomy, the aorta was excised and the orifice of the ARSA was exposed. There was no sign of infection in the operative field. Bleeding from the ARSA was controlled by balloon occlusion. The proximal portion of the right vertebral artery was ligated and blood backflow from the ARSA stopped. The ARSA was ligated proximal to the aneurysm, and the orifice of the ARSA to the aorta was closed. The infected aneurysm was not resected. The descending aorta was replaced by a rifampin-bonded artificial graft, and omentopexy was performed. Gastrostomy was performed for decompression of the oesophagus and enteric feeding. Three months after the operation, gastrointestinal endoscopy showed a healed oesophageal ulcer, and the patient was discharged uneventfully.
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Affiliation(s)
- Shinya Takahashi
- Department of Surgery, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan.
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23
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Pop D, Venissac N, Nadeemy AS, Schneck AS, Aze O, Mouroux J. Lesson to be learned: beware of lusoria artery during transhiatal esophagectomy. Ann Thorac Surg 2012; 94:1010-1. [PMID: 22916758 DOI: 10.1016/j.athoracsur.2012.01.092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 01/18/2012] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
Abstract
The presence of an aberrant right subclavian artery represents a potentially risky situation when high mediastinal surgery is planned. We report a case of a patient needing transhiatal esophagectomy for cancer; the presence of the abnormal anatomic arterial situation complicated the postoperative course, when a vascular- digestive fistula appears. We discuss the direct causes and consequences of a rare situation.
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Affiliation(s)
- Daniel Pop
- Department of Thoracic Surgery, Pasteur Hospital, Nice, France.
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24
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Soga K, Kitamura R, Takenaka S, Kassai K, Itani K. Progressive endoscopic findings in a case of aortoesophageal fistula. Dig Endosc 2012; 24:290. [PMID: 22725126 DOI: 10.1111/j.1443-1661.2011.01218.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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25
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Shinkawa T, Greenberg SB, Jaquiss RD, Imamura M. Primary Translocation of Aberrant Left Subclavian Artery for Children With Symptomatic Vascular Ring. Ann Thorac Surg 2012; 93:1262-5. [DOI: 10.1016/j.athoracsur.2011.12.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/06/2011] [Accepted: 12/08/2011] [Indexed: 11/25/2022]
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26
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Choi JH, Byun CS, Kim SM, Hwang JJ. Esophageal-Retroesophageal Right Subclavian Artery Fistula - A Case Report -. Korean J Crit Care Med 2012. [DOI: 10.4266/kjccm.2012.27.3.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jin Ho Choi
- Department of Cardiothoracic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Chun Sung Byun
- Department of Cardiothoracic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Seong Min Kim
- Department of Neurosurgery, Eulji University Hospital, Daejeon, Korea
| | - Jung Joo Hwang
- Department of Cardiothoracic Surgery, Eulji University Hospital, Daejeon, Korea
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27
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Near-fatal bleeding from an aberrant subclavian artery following colonic interposition for oesophageal atresia. Pediatr Surg Int 2011; 27:1131-3. [PMID: 21400029 DOI: 10.1007/s00383-011-2881-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2011] [Indexed: 10/18/2022]
Abstract
An unusual complication following colonic interposition for oesophageal atresia is described, where a fistula between an aberrant right subclavian artery and the colon graft caused severe haemorrhage. As in cases of aorto-oesophageal fistulae from foreign body ingestion, we experienced a 'herald'-bleed before a second near-fatal event. In such cases, the clinical assumption should be that the source of bleeding is a major artery and appropriate resuscitation including preparations for immediate thoracotomy is required. Consideration should also be given to this potential complication when using the mediastinal route for an oesophageal replacement graft.
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28
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Chapman JR, Sedghi S, Christie BD, Nakayama DK, Wynne JL. Aberrant Right Subclavian Artery–Esophageal Fistula. Am Surg 2010. [DOI: 10.1177/000313481007601237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jason R. Chapman
- Mercer University School of Medicine and Medical Center of Central Georgia Macon, Georgia
| | - Shahriar Sedghi
- Mercer University School of Medicine and Medical Center of Central Georgia Macon, Georgia
| | - Benjamin D. Christie
- Mercer University School of Medicine and Medical Center of Central Georgia Macon, Georgia
| | - Don K. Nakayama
- Mercer University School of Medicine and Medical Center of Central Georgia Macon, Georgia
| | - Julie L. Wynne
- Mercer University School of Medicine and Medical Center of Central Georgia Macon, Georgia
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29
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Lee CY, Moraca RJ, Benckart DH, Bailey SH, Magovern GJ, Muluk S. Thoracic endovascular aortic repair of an aberrant right subclavian artery: technique and long-term outcome. J Card Surg 2010; 25:390-3. [PMID: 20529153 DOI: 10.1111/j.1540-8191.2010.01058.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Aberrant right subclavian artery (ARSA) is the most common congenital arch anomaly, which can be complicated by aneursymal dilation at its ostium. We describe a successful repair of an ARSA with a three-stage operative procedure using a left carotid to subclavian bypass, coiling of the ARSA, and thoracic endovascular aortic repair with long-term clinical and radiographic follow-up.
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Affiliation(s)
- Candace Y Lee
- Department of Cardiovascular and Thoracic Surgery, Allegheny General Hospital, Pittsburgh, PA 15212, USA
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30
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Fuentes S, Cano I, López M, Moreno C, Tejedor R, Marianeschi S, García E, Gómez A. Arterial-esophageal fistula: a severe complication in children with cardiovascular abnormalities. Pediatr Surg Int 2010; 26:335-7. [PMID: 19921214 DOI: 10.1007/s00383-009-2532-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2009] [Indexed: 11/25/2022]
Abstract
Fistulae between esophagus and major arteries are an extremely rare and severe condition. They have been described in patients with previous impairment or abnormalities of mediastinal vessels and intraesophageal increased pressure or as a complication of cardiovascular procedures. We report three cases of children with an aorto-esophageal fistula, a collateral pulmonary artery-esophageal fistula and an aberrant right subclavian artery-esophageal fistula that were successfully managed in coordination with pediatricians, anesthesiologists and both cardiovascular and pediatric surgeons. The severity of this pathology makes it important to suspect it and treat it by a multidisciplinary group of physicians.
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Affiliation(s)
- Sara Fuentes
- Hospital Universitario 12 de Octubre, Madrid, Spain.
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31
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Myers PO, Fasel JHD, Kalangos A, Gailloud P. Arteria lusoria: developmental anatomy, clinical, radiological and surgical aspects. Ann Cardiol Angeiol (Paris) 2009; 59:147-54. [PMID: 19962688 DOI: 10.1016/j.ancard.2009.07.008] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Accepted: 07/15/2009] [Indexed: 11/26/2022]
Abstract
The left aortic arch with an aberrant right subclavian artery, or arteria lusoria, is the most common aortic arch anomaly, occuring in 0.5-2.5% of individuals. Four vessels arise sequentially from the aortic arch: the right common carotid artery, the left common carotid artery, the left subclavian artery and the aberrant right subclavian artery, which crosses upwards and to the right in the posterior mediastinum. It results from a disruption in the complex remodelling of the paired branchial arches, typically of the right dorsal aorta distal to the sixth cervical intersegmental artery. The diagnosis and differentiation of arch anomalies is based on findings at chest radiography in association with those at esophagography. It is usually asymptomatic. When symptomatic, it produces dysphagia lusoria or dyspnea and chronic coughing. Treatment is indicated for symptomatic relief of dysphagia lusoria and for prevention of complications due to aneurysmal dilatation.
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Affiliation(s)
- P O Myers
- Division of Cardiovascular Surgery, Geneva University Hospital, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
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32
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Palacios Cuesta A, Domínguez García O, Mendoza Soto A, Uricchio N, Sánchez Díaz J. Hemorragia digestiva masiva por fistulización al esófago de una colateral aortopulmonar. An Pediatr (Barc) 2008; 69:288-9. [DOI: 10.1157/13125833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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33
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Abstract
Double aortic arch is a common form of complete vascular ring that encircles both the trachea and the esophagus, and presents with various respiratory and esophageal symptoms, usually in the pediatric population. We present a case of double aortic arch in an adult patient that manifested as massive upper gastrointestinal bleeding after prolonged nasogastric intubation.
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34
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Millar A, Rostom A, Rasuli P, Saloojee N. Upper gastrointestinal bleeding secondary to an aberrant right subclavian artery-esophageal fistula: a case report and review of the literature. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2007; 21:389-92. [PMID: 17571174 PMCID: PMC2658123 DOI: 10.1155/2007/398213] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An aberrant right subclavian artery (ARSA) is a common aortic arch abnormality. A case of a 57-year-old man presenting with melena and hypotension secondary to an ARSA-esophageal fistula is reported. The current report is unique because it is the first reported case of ARSA-esophageal fistula associated with prior esophagectomy and gastric pull-up. A MedLine search was performed for ARSA-esophageal fistula cases, which were then compared with the present case. Because this patient had no vascular conduits, nasogastric or endotracheal tubes, the fistula likely occurred secondary to the previous surgery. This case is unusual because the patient survived the original hemorrhage associated with the ARSA-esophageal fistula. An ARSA-esophageal fistula is a rare, but potentially fatal cause of upper gastrointestinal bleeding. A high index of suspicion is needed to make the diagnosis. This condition should be considered in patients with risk factors combined with hemodynamically significant gastrointestinal bleeding.
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Affiliation(s)
- Adam Millar
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Alaa Rostom
- Division of Gastroenterology, The Ottawa Hospital, Ottawa, Ontario
| | - Pasteur Rasuli
- Division of Radiological Imaging, The Ottawa Hospital, Ottawa, Ontario
| | - Nav Saloojee
- Division of Gastroenterology, The Ottawa Hospital, Ottawa, Ontario
- Correspondence: Dr Nav Saloojee, Division of Gastroenterology, The Ottawa Hospital, Ottawa, Ontario. Telephone 613-737-8899 ext 76420, fax 613-737-8599, e-mail
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35
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Vanden Eynden F, Devière J, Laureys M, de Cannière D. Erosion of a retroesophageal subclavian artery by an esophageal prosthesis. J Thorac Cardiovasc Surg 2006; 131:1183-1184.e1. [PMID: 16678615 DOI: 10.1016/j.jtcvs.2005.12.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Accepted: 12/01/2005] [Indexed: 12/21/2022]
Affiliation(s)
- Frédéric Vanden Eynden
- Service de Chirurgie Cardiaque, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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36
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Snajdauf J, Mixa V, Rygl M, Vyhnánek M, Morávek J, Kabelka Z. Aortoesophageal fistula--an unusual complication of esophagitis caused by Dieffenbachia ingestion. J Pediatr Surg 2005; 40:e29-31. [PMID: 15991162 DOI: 10.1016/j.jpedsurg.2005.03.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aortoesophageal fistula (AEF) is a rare and mostly lethal cause of upper gastrointestinal bleeding in children. We report a successful outcome of surgical treatment after resuscitation of a girl aged 12 1/2 years with AEF as a complication of esophagitis caused by Dieffenbachia ingestion. The girl ate a leaf of Dieffenbachia picta in a suicidal attempt. After 5 weeks of medical treatment of esophagitis, small blood-stained vomitus and melena appeared. Within a few hours, it was followed by a massive gastrointestinal bleeding leading to exsanguination. The girl survived despite the pitfalls in clinical presentation and errors in diagnostic approach and treatment. Emergency exploration of cervical esophagus, followed by laparotomy and thoracotomy, was performed in attempt to find the source of bleeding and to control it. Aortoesophageal fistula was located between the ascending aorta near the origin of the brachiocephalic trunk and thoracic esophagus. Resection of the fistula led to prompt circulatory stabilization. The common houseplant, Dieffenbachia picta, causes edematous swelling of mucus membranes when chewed. Dieffenbachia-caused esophagitis is very rare and this etiology of AEF has not been reported in children.
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Affiliation(s)
- Jirí Snajdauf
- Department of Pediatric Surgery, Charles University of Prague, 2nd Medical School, Teaching Hospital Motol, Institute of Postgraduate Medicine, 150 00 Prague, Czech Republic
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37
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Poultsides GA, Lolis ED, Vasquez J, Drezner AD, Venieratos D. Common Origins of Carotid and Subclavian Arterial Systems: Report of a Rare Aortic Arch Variant. Ann Vasc Surg 2004; 18:597-600. [PMID: 15534741 DOI: 10.1007/s10016-004-0060-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
An aberrant right subclavian artery (aSA) arising from the proximal descending aorta is one of the most common anomalies of the aortic arch. We present our experience with an asymptomatic atypical aSA variant found during routine anatomic dissection. This aortic arch variant had two branches, the first being a bicarotid trunk and the second being a common trunk for both subclavian arteries. The right subclavian artery traveled behind the esophagus to reach the right upper extremity, thus forming an incomplete vascular ring around the trachea and the esophagus. The literature has been silent about the existence of this exact aSA variation. A plausible embryologic explanation is provided. An aSA is rarely symptomatic, but when symptoms do occur and intervention is warranted, it is important for surgeons and radiologists alike to be aware of the vascular anomalies that may potentially coexist with this entity. The surgical and endovascular options associated with this unique vascular anomaly are also discussed.
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Affiliation(s)
- George A Poultsides
- Department of Anatomy, University of Athens School of Medicine, Athens, Greece.
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38
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Feugier P, Lemoine L, Gruner L, Bertin-Maghit M, Rousselet B, Chevalier JM. Arterioesophageal fistula: a rare complication of retroesophageal subclavian arteries. Ann Vasc Surg 2003; 17:302-5. [PMID: 12704542 DOI: 10.1007/s10016-001-0406-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Formation of a fistula between a retroesophageal subclavian artery and the esophagus is a rare cause of hematemesis that is usually fatal. Several etiologies have been described. The purpose of this report is to describe a case involving successful surgical repair of an arterioesophageal fistula induced by prolonged nasogastric intubation. A preoperative CT scan under emergency conditions allowed tentative diagnosis. Arteriography in the operating room confirmed the presence of a fistula and also allowed temporary hemostasis by tamponade. On the basis of a review of the literature, this case demonstrates the importance of screening patients requiring prolonged nasogastric intubation to rule out the possibility of an aberrant aortic arch system.
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Affiliation(s)
- Patrick Feugier
- Service de Chirurgie Vasculaire, Hôpital Edouard Herriot, Lyon, France.
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39
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Feugier P, Lemoine L, Beaudoin N, Chevalier JM. Aberrant right subclavian arterioesophageal fistula: endovascular occlusion via a transbrachial approach. Eur J Vasc Endovasc Surg 2002; 23:77-8. [PMID: 11748953 DOI: 10.1053/ejvs.2001.1512] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- P Feugier
- Service de Chirurgie Vasculaire, Pavillon M1, Hôpital E. Herriot, 69 437 Lyon, Cedex 03, France
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40
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Dicle O, Secil M, Goktay AY, Akbaylar H. Subclavian artery aneurysm with oesophagoarterial fistula. Br J Radiol 1999; 72:1208-10. [PMID: 10703479 DOI: 10.1259/bjr.72.864.10703479] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aneurysms of the subclavian artery are rare. Fistula formation between the subclavian artery and the oesophagus has been described in aberrant subclavian artery and oesophageal foreign body. However, a fistula between a non-aberrant subclavian artery aneurysm and the oesophagus has not been previously reported. In this report, an unusual case of subclavian artery aneurysm with a fistula to the oesophagus causing intractable haematemesis is presented with the angiographic findings.
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Affiliation(s)
- O Dicle
- Department of Radiology, Dokuz Eylul University Hospital, Inciralti Izmir, Turkey
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