366. MINIMALLY INVASIVE MANAGEMENT OF AORTO-OESOPHAGEAL FISTULA: THORACIC ENDOVASCULAR AORTIC REPAIR AND THORACOSCOPIC ASSISTED OESOPHAGECTOMY WITH DELAYED GASTRIC CONDUIT RECONSTRUCTION

Abstract

Abstract Background Development of aorto-oesophageal fistula (AOF) within the context of thoracic aortic aneurysm is rare and carries a high mortality rate. Here we present two cases detailing the successful management of AOF. Methods A 58 year old male presented with haematemesis. CT angiogram demonstrated fistulation between a mycotic aneurysmal thoracic aorta and the oesophagus. He underwent Thoracic Endovascular Aneurysm Repair (TEVAR). This was followed by thoracoscopic assisted oesophagectomy (TAO) and delayed gastric conduit reconstruction. A 49 year old female presented with massive haematemesis. CT angiogram demonstrated a calcified thoracic aneurysmal sac. This was managed with TEVAR. Subsequent investigations revealed mediastinitis, stent graft infection and AOF. This was managed with TAO and delayed gastric conduit reconstruction. Results Gastric conduit reconstruction achieved an excellent functional result in both patients. Ongoing Aortic CT surveillance has revealed satisfactory appearances with no current plans for further vascular intervention. Both patients have returned to full employment. Conclusions TEVAR should be used as the initial bridging intervention to stabilise haemodynamically unstable patients with AOF. Subsequent oesophageal resection can be safely performed using a minimally invasive approach with subsequent retro-sternal reconstruction using a gastric conduit. CT follow up demonstrate no ongoing issues with the implanted aortic stents