Abstract
BackgroundDysphagia aortica is an umbrella term to describe swallowing obstruction from external aortic compression secondary to a dilated, tortuous, or aneurysmal aorta. We performed a systematic literature review to clarify clinical features and outcomes of patients with dysphagia aortica.Materials and methodsWe searched PubMed, EMBASE, Web of Science, and the Cochrane Library. The terms “aortic dysphagia,” “dysphagia aortica,” “dysphagia AND aortic aneurysm” were matched. We also queried the prospectively updated database of our esophageal center to identify patients with aortic dysphagia referred for diagnosis and treatment over the past two decades.ResultsA total of 57 studies including 69 patients diagnosed with dysphagia aortica were identified, and one patient from our center was added to the database. The mean age was 72 years (range 22–98), and the male to female ratio 1.1:1. Of these 70 patients, the majority (n = 63, 90%) had an aortic aneurysm, pseudoaneurysm, or dissection. Overall, 37 (53%) patients received an operative treatment (81.1% a vascular procedure, 13.5% a digestive tract procedure, 5.4% both procedures). Thoracic endovascular aortic repair (TEVAR) accounted for 60% of all vascular procedures. The postoperative mortality rate was 21.2% (n = 7/33). The mortality rate among patients treated conservatively was 55% (n = 11/20). Twenty-six (45.6%) studies were deemed at a high risk of bias.ConclusionDysphagia aortica is a rare clinical entity with high morbidity and mortality rates and no standardized management. Early recognition of dysphagia and a high suspicion of aortoesophageal fistula may be lifesaving in this patient population.
Highlights
Dysphagia is a common symptom reported by 10–33% of elderly individuals in the community and nursing home settings [1, 2], the true prevalence is likely underestimated because many patients adapt through behavioral changes [3]
Recognition of dysphagia and a high suspicion of aortoesophageal fistula may be lifesaving in this patient population
Most patients reported in the literature were diagnosed with aortic aneurysm, pseudoaneurysm, or dissection
Summary
Dysphagia is a common symptom reported by 10–33% of elderly individuals in the community and nursing home settings [1, 2], the true prevalence is likely underestimated because many patients adapt through behavioral changes [3]. The term dysphagia aortica was first introduced by Pape [4] in 1932 to describe dysphagia caused by external aortic compression from an aneurysmal, dilated, or tortuous aorta [5]. Primary aortoesophageal fistula (AEF) is the most feared complication [7], typically in the setting of untreated thoracic aortic aneurysm (TAA) that occurs in 5–10 per 100,000 person years [8]. This may be asymptomatic and diagnosed incidentally, or it may present with symptoms due to mediastinal compression or with dissection or rupture in the worst-case scenario. The typical presentation of AEF was first described by Chiari [9] as a triad of chest pain, sentinel hematemesis, and final massive hemorrhage with exsanguination after a symptom-free interval
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