Abstract
A 73-year-old man presented with melena. After a thorough workup including esophageal endoscopy, computed tomography scans, and esophagography, the diagnosis of secondary aortoesophageal fistula was made. Two years previously, he had undergone endovascular stent-graft repair for the dissection of his descending thoracic aorta. Because of the generally poor condition of the patient and the high risk of any aggressive surgical intervention, we inserted a covered self-expanding esophageal stent on postadmission day 18. Esophagography after insertion did not show any evidence of a leak of contrast medium. Despite treatment with antibiotics, he developed sepsis and expired on day 52, but rebleeding did not occur in this period. We consider insertion of a covered self-expanding esophageal stent as a feasible option in the management of secondary aortoesophageal fistula in high-risk patients.
Highlights
Secondary aortoesophageal fistula (AEF) after thoracic endovascular aortic repair (TEVAR) is relatively rare [1,2,3,4,5,6], with a reported incidence of 1.7% to 1.9% [4, 7]
We describe a case of secondary AEF with insertion of a covered self-expanding esophageal stent to control gastrointestinal bleeding
Conservative management is the mainstay of treatment of secondary AEF after TEVAR as most of these patients have contraindications to major surgery given their poor general condition [4, 6,7,8,9]
Summary
Secondary aortoesophageal fistula (AEF) after thoracic endovascular aortic repair (TEVAR) is relatively rare [1,2,3,4,5,6], with a reported incidence of 1.7% to 1.9% [4, 7]. Treatment options are very limited, as these patients are usually not candidates for open surgery. Outcomes with conservative management are almost always fatal due to recurrent hemorrhage or chronic mediastinitis. There are no treatments to manage spontaneous, recurrent hemorrhage. We describe a case of secondary AEF with insertion of a covered self-expanding esophageal stent to control gastrointestinal bleeding
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have