Surgical treatment for secondary aortoesophageal fistula
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(2020) 15:251
RESEARCH ARTICLE
Open Access
Surgical treatment for secondary aortoesophageal fistula Kayo Sugiyama1* , Toru Iwahashi2, Nobusato Koizumi2, Toshiya Nishibe2, Toshiki Fujiyoshi2 and Hitoshi Ogino2
Abstract Background: Aortoesophageal fistula (AEF) is a relatively rare condition that is often life-threatening. Secondary AEF is a complication of previous surgery, which can be more critical and challenging than primary AEF. The number of secondary AEF is increasing due to increase in the number of thoracic endovascular aortic repair (TEVAR). Although TEVAR has become a successful alternative surgical strategy for thoracic aortic aneurysms, secondary AEF after TEVA R might be critical than other secondary AEF because of severe adhesion between the esophagus and residual thoracic aortic wall. Methods: This study analyzed six patients with secondary AEF who were treated at Tokyo Medical University Hospital between 2011 and 2016. These participants included four patients who had undergone TEVAR and two who had undergone total arch replacement. Results: Although they were subsequently hospitalized for a long period, open surgical repair was completed in two patients who had undergone total arch replacement. TEVAR alone was performed in two patients who had undergone TEVAR and they were discharged without major complications shortly. Combined repair of TEVAR as a bridge to open surgery was planned for two patients who had undergone TEVAR. However, reconstruction of the aorta and esophagus could not be completed in these patients due to severe adhesions, and they died during hospitalization. Conclusions: Definitive open repair was successfully performed in patients with secondary AEF after total arch replacement. However, in the patients with secondary AEF after TEVAR, severe adhesion between the aorta and esophagus led to difficulty in performing a successful definitive open repair. The strategy for secondary AEF should, therefore, be decided considering the etiology of secondary AEF. In secondary AEF after TEVAR, definitive open repair is difficult to complete because of catastrophic complication, and palliative treatment using TEVAR without reconstruction of aorta and esophagus can be an alternative. Keywords: Secondary aortoesophageal fistula, Thoracic endovascular aortic repair, Total arch replacement
Background Aortoesophageal fistula (AEF) is a relatively rare condition that is often life-threatening [1–3]. Secondary AEF, a complication of surgery in the posterior mediastinum can be more critical than primary AEF because of the presence of adhesion in the pleural space and the poor general status of patients. The number of secondary AEF * Correspondence: [email protected] 1 Department of Cardiac Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan Full list of author information is available at the end of the article
is increasing due to increase in the number of TEVAR. There have been few studies comparing the surgical results for secondary AEF cases [4, 5] and op
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