Aortic-esophageal Fistula Research Articles

Aotric esophageal fistula: etiopathogenesis and diagnostics (review of literature)

Aortic esophageal fistula (AEF) is a rare but extremely life-threatening condition requiring immediate surgical treatment. The mortality rate among such patients may exceed 60 %, including after surgical treatment. Etiological and pathogenetic mechanisms of AEF are complex and various, but in most cases, they are associated with chronic aortic diseases. The second group of etiological factors of AEF includes trauma of esophagus wall by foreign bodies, malignant neoplasms of the esophagus or mediastinum. AEF may also occur as a result of surgical interventions on the aorta and esophagus. The difficulties of early diagnosis are primarily associated with non-specific clinical manifestations of AEF and the lack of unified protocol for the examination of patients with the first-time upper gastrointestinal tract bleeding. The described reasons in some cases can lead to an inaccurate diagnosis, which entails a loss of time. Among the instrumental diagnostic methods, the most informative is the combination of esophagogastroduodenoscopy and computed tomography of the chest with intravenous contrast enhancement. Each of these methods has its advantages and disadvantages, and allows to identify a number of direct and indirect signs of pathological communication between the aorta and the esophagus.

Review of a 10-year single center experience in treatment of thoracoabdominal aortic trauma

Objective To review the case data and treatment methods in a single center so as to search for rational treatments for thoracoabdominal aortic trauma. Methods This retrospective analysis was performed for 34 cases (28 males and 6 females) sustaining thoracoabdominal aortic trauma treated from October 2002 to February 2013. The mean age was 41 years (range, 11-60 years). Causes of injury included traffic crashes in 14 cases, high falls in 7, stab wound in 3, abdominal crash injury in 3, aorticoesophageal fistula caused by a fish bone in 3, interventional therapy-induced aortic dissection in 2, abdominal aortic injury caused by the dropped ventricular septal defect occluder in 1, and accidental aortic injury in spinal operation in 1. There were 23 cases of thoracic aortic trauma (6 sharp and 17 blunt) and 11 cases of abdominal aortic trauma (4 sharp and 7 blunt). Preoperative imaging findings, treatment methods and follow-up data were studied. Results Personal treatment was produced based on the mechanism of injury and imaging findings. Of sharp thoracic aortic trauma, 2 cases were treated non-operatively but both died, and four cases had endovascular repair (one progressed, two cured, and one died). All the four cases of sharp abdominal aortic trauma had open surgery (three cured and one severely complicated). Of thoracic aortic trauma, four cases were treated non-operatively (three cured and one died), twelve cases had endovascular repair (11 cured and one died), and one case had open surgery and cured. Six cases of blunt abdominal aortic trauma were treated non-operatively and one had open surgery. Conclusions Treatment of aortic trauma should be based on injury condition, injury site, and occurrence of aortic rupture or impending of aortic rupture. Endovascular repair has a high success rate and good clinical outcome in treatment of thoracoabdominal aortic trauma. Key words: Aorta; Wounds and injures; Endovascular repair

Esophageal Fistualization: 3 Rare Cases

Purpose: Esophageal fistualization occurs secondary to infection, malignancy, mechanical perforation, radiation injury, congenital abnormalities, or surgical procedures. We present three uncommon etiologies of esophageal fistulas with interesting presentations. Methods: A 48 year old male with medical history of intravenous drug abuse, spinal stenosis, and a prolonged hospitalization with multi-drug resistant bacteremia presented two months after discharge with acute onset of shortness of breath and worsening back pain. He was found to have MSSA vertebral osteomyelitis. CT with contrast of the chest revealed a 2.5x5 cm subcarinal/paraesophageal mass. EGD/EUS showed a complex fluid collection with purulent discharge into a mucosal deformity of the proximal esophageal lumen. MRI showed contiguous spread of a posterior mediastinal abscess resulting in esophageal fistualization. He was treated with surgical drainage and long-term antibiotics. To our knowledge, this is the first reported case of vertebral osteomyelitis and posterior mediastinal abscess resulting in esophagorespiratory fistula. Results: An 81 year old female presented with low grade fevers, productive cough, and paroxysms of choking associated with solids and liquids. She had endoscopic thoracic aneurysm repair (ETAR) one month prior to admission. Videofluorographic swallowing study revealed mild to moderate bolus stasis at the mid to distal esophagus. EGD subsequently showed a mid esophageal non-obstructing stable clot penetrating from the muscular layer. A gastrogaffin UGI series showed a mid to distal esophageal leakage of contrast material, consistent with aorto-esophageal fistula. These findings are consistent with a thoracic aortic aneurysm forming an aortic esophageal fistula (AEF) and a rare cause of gastrointestinal bleeding. This patient subsequently required surgical intervention for AEF repair. AEF cause approximately 0.01- 0.08% of UGIB. Classically, the Chiari triad of AEF is midthoracic pain or dysphagia, a sentinel episode of hematemesis, and fatal exsanguinations. Conclusion: A 53 year old female presented for EUS guided FNA of a submucosal esophageal lesion arising from the muscularis propria. A FNA was performed using a 22g needle was done. One week later the patient developed progressively worsening back pain with debilitating consequences. CT demonstrated a posterior mediastinal fluid collection tracking from the esophagus to the pre-spinal area, suggestive of an epidural abscess with cord compression. The patient was treated with surgical drainage and antibiotics. The cultures were positive for S. viridians and antibiotics were initiated. We feel blood tracking from the FNA tract may have resulted in esophago-spinal fistula.

Ruptured thoracic aortic aneurysm in patient with systemic lupus erythematosus

It is reported a ruptured descending thoracic aortic aneurysm in a 25-year-old systemic lupus erythematosus woman who underwent 19 years steroid therapy. She was treated with 2 endovascular stent-grafts, discharged from hospital 13 days after the procedure in good health. Three months later she returned with hemorrhagic shock due to high digestive hemorrhage secondary to an aortic-esophageal fistula. She underwent to an open emergency surgery, and died during the post-operative period.

Fatal aortic oesophageal fistula following oesophageal foreign body removal in a dog

An eight-month-old male Pomeranian was presented with hypovolaemic shock 7 days after successful oesophageal foreign body removal. On presentation the dog was anaemic and no coagulation abnormalities were detected. A fluid-filled oesophagus was visible on thoracic radiography and frank blood was aspirated from the oesophagus following oro-oesophageal intubation. Fluid resuscitation and blood transfusions were administered but attempts at stabilisation were unsuccessful and the dog died. At post-mortem examination, a 2-mm aortic oesophageal fistula was identified on the ventral aspect of the aorta at the level of heart base that communicated with the overlying oesophagus. Aortic oesophageal fistula has been reported in human medicine and occurs secondary to a number of conditions including oesophageal foreign bodies. These prove fatal without rapid stabilisation and surgery.

Fístula aortoesofágica após correção endovascular da dissecção de aorta torácica tipo B de Stanford

A correção endovascular da dissecção de aorta tipo B tem se mostrado como uma nova alternativa para reduzir o trauma cirúrgico. No entanto, as complicações de médio e longo prazo, tais como a fístula aortoesofágica, são ainda pouco conhecidas e pouco relatadas. O objetivo deste trabalho é descrever três casos de fístula aortoesofágica após o tratamento endovascular de 23 casos de dissecção de aorta descendente conduzidos pela equipe de Cirurgia Vascular da Santa Casa de São Paulo em um estudo retrospectivo. Esses pacientes apresentavam características em comum, como dissecção crônica, pós-operatório imediato sem intercorrências, necessidade de reintervenções, oclusão de troncos arteriais como a artéria subclávia, mesentérica, tronco celíaco, e, ainda, uma rápida evolução para o óbito após os primeiros sinais de fístula. Portanto, embora raramente descrita na literatura, a ocorrência de fístula aortoesofágica é uma complicação de causa até o momento indefinida do tratamento endovascular da dissecção de aorta descendente que merece atenção, dada sua recorrência e evolução fatal.

Device-spezifische Probleme thorakaler Endostents

The outcome of the endovascular repair of abdominal aortic aneurysms seems to be device related. The presented study evaluated the outcome of endovascular procedure in cases of thoracic aortic pathology according to the implanted thoracic stent graft devices. Since November 1999 a variety of thoracic aortic pathologies in 59 patients has been treated endovascularly. The median age of the cohort (53 males, 6 females) was 64 years (rang, 21 to 83). The patients presented the following aortic morphology: aneurysm n = 23, dissections with aneurysm n = 9, dissection without aneurysm n = 9, intramural hematoma n = 2, penetrating ulcers n = 2, transsection n = 8, false aneurysm n = 6. The underlying pathology was: atherosclerotic medial degeneration n = 25, acute dissection (< 14 days) n = 10, chronic dissection (> or = 14 days) n = 10, trauma n = 8, iatrogenic n = 6. Three patients presented the symptoms of aortic pulmonary fistulas; one patient was treated due to traumatic aortic oesophageal fistula. The used stent graft devices included the GORE TAG (n = 35), the Talent device (n = 13), the Cook device (Zenith TX 1: n = 5), and the Endofit device (n = 3). At three cases a home-made device (n = 1) or a combination of different stent grafts was implanted (Talent plus TAG, Talent plus TX1). Totally, 93 stent grafts were primarily implanted. The 30-day mortality was 1 / 59. One patient with acute dissection (Stanford type B) suffered from a per-procedural acute retrograde dissection leading to death in spite of the performed Bentall's procedure. Per-operatively, one patient showed cerebral ischemia, one other patient experienced a transsection of the external iliac artery due to the retraction of the introducer sheath, and another patient showed an extravasation of contrast dye. 24 hours following the endovascular procedure, one patient developed paraplegia without regression in spite of performing a spinal drainage. The passage of the introducer sheath of the primarily chosen device was impossible at three cases, in another three cases type I endoleaks were detectable, a type III endoleak was evident at another patient with formerly implanted multiple stent grafts. The results of the endovascular procedures in treatment of thoracic aortic pathologies demonstrated typically device related problems and unwanted events. Various types of stent grafts, introducer sheaths, and delivery systems may be necessary to satisfy the different requirements for different indications.

CANDIDA INFECTION COMPLICATING PEPTIC ESOPHAGEAL ULCER. INFECTION IN AN AORTIC-ESOPHAGEAL FISTULA.

Communication between the esophagus and the aorta occurs uncommonly. The usual cause is trauma1incurred by the ingestion of a foreign body, or less often by surgery or penetrating chest wound. Another prominent cause of aortic-esophageal fistulae is carcinoma of the esophagus.2Aortic-esophageal fistulae are usually located at the level of the aortic arch1where these two structures are approximated most closely. The present communication presents what seems to be a unique situation. A patient who was trained in esophageal speech after total laryngectomy developed a hiatus hernia with peptic ulceration at the esophageal-gastric junction. This ulcer penetrated posteriorly into the aorta and produced fatal massive hematemesis through the resultant aortic-esophageal fistula. At postmortem examination yeast-like organisms, morphologically characteristic ofCandida, were found in the wall of the aorta along the fistulous tract. Report of a Case A 62-year-old white man was admitted to the West Haven

Aortic-Esophageal Fistula: Attempted Surgical Repair

Aortic-Esophageal Fistula: Attempted Surgical Repair

Aortic esophageal fistula secondary to achalasia accompanied by megaesophagus and esophageal ulceration.

MOST cases of aortic esophageal fistula have been due to ingestion of foreign bodies, especially animal bones. A much rarer cause has been esophageal diverticulum.§ The following case presents a hitherto unreported cause of aortic esophageal fistula — that is, a fistula secondary to achalasia, with accompanying megaesophagus and esophageal ulceration.Case ReportA 63-year-old man was admitted to the general medical ward in peripheral circulatory collapse on January 3, 1958, at 12:05 p.m., with a history of 6 episodes of massive hematemesis over the prior 4 hours. For 1 month he had had epigastric pain, anorexia and abdominal bloating. . . .

Fatal Aortic--Oesophageal Fistula from a Swallowed Piece of Bone

Fatal Aortic--Oesophageal Fistula from a Swallowed Piece of Bone