Management of Tumor- and Nontumor-related Aorto-esophageal and Aorto-bronchial Fistulas

Abstract

This study aims to review and compare the clinical presentation, management, and outcome in patients with tumor-related (TR) and nontumor-related (NTR) aorto-esophageal fistula (AEF) and aorto-bronchial fistula (ABF) with particular focus on the thoracic endovascular aortic repair. We retrospectively reviewed a series of 16 consecutive patients with TR (n=8) and NTR (n=8), ABF (n=6), and AEF (n=10) admitted to our hospital from 2011 to2019. The median age was 62years (range 46-81), with 11 men. The most common predisposing factor was esophageal or gastric cardia cancer (n=6), followed by open repair of the thoracic aorta (n=5). Endoluminal vacuum therapy (Endo-SPONGE®) accounted for 3 cases of AEFs. Thoracic endovascular aortic repair (TEVAR) was applied in 13 patients (4 with ABFs and 9 with AEFs). The primary technical success of the TEVARs was 100%. One patient (8%) was complicated with postoperative middle cerebral artery syndrome and left-sided hemiparesis. The respective in-hospital, 6-month, and 1-year mortality rates were 0% (n=0), 25% (n=2), and 25% (n=2) for the NTR group and 63% (n=5), 88% (n=7), and 100% (n=8) for the TR group. After a mean period of 13months, 5 (31%) patients were still alive, and one patient lost to follow-up after 11months. The survivors (n=5) had all nontumor-related ABF. Progression of underlying cancer and hemodynamic shock were the most common causes of death. TEVAR represents a reliable option in the treatment of NTR ABFs. In the cases of TR fistulas and NTR AEFs, TEVAR should be applied more selectively. The associated mortality remains very high.