Document Detail


Acute management of aortobronchial and aortoesophageal fistulas using thoracic endovascular aortic repair.
MedLine Citation:
PMID:  19481408     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Aortobronchial fistula (ABF) and aortoesophageal fistula (AEF) are rare but lethal if untreated; open thoracic surgery is associated with high operative mortality and morbidity. In this case series, we sought to investigate outcomes of thoracic endovascular aortic repair (TEVAR) for emergency cases of ABF and AEF.
METHODS: We retrospectively reviewed all patients with AEF and ABF undergoing TEVAR in three European teaching hospitals between 2000 and January 2009. Eleven patients were identified including 6 patients with ABF, 4 patients with AEF, and 1 patient with a combined ABF and AEF. In-hospital outcomes and follow-up after TEVAR were evaluated.
RESULTS: Median age was 63 years (interquartile range, 31); 8 were male. Ten patients presented with hemoptysis or hematemesis; 4 developed hemorrhagic shock. All patients underwent immediate TEVAR, and 3 AEF patients required additional esophageal surgery. Five patients died (45%), including 3 patients with AEF, 1 patient with ABF, and 1 patient with a combined ABF and AEF, after a median duration of 22 days (interquartile range, 51 days). The patient with AEF that survived had received early esophageal reconstruction. Causes of death were: sepsis (n = 2), acute respiratory distress syndrome (ARDS) (n = 1), thoracic infections (n = 1), and aortic rupture (n = 1). Median follow-up of surviving patients was 45 months (interquartile range, 45 months). Six additional vascular interventions were performed in 3 survivors.
CONCLUSION: TEVAR does prevent immediate exsanguination in patients admitted with AEF and ABF, but after initial deployment of the endograft and control of the hemodynamic status, most patients, in particular those with AEF, are at risk for infectious complications. Early esophageal repair after TEVAR appears to improve the survival in case of AEF. Therefore, TEVAR may serve as a bridge to surgery in emergency cases of AEF with subsequent definitive open operative repair of the esophageal defect as soon as possible. In patients with ABF, additional open surgery may not be necessary after the endovascular procedure.
Authors:
Frederik H W Jonker; Robin Heijmen; Santi Trimarchi; Hence J M Verhagen; Frans L Moll; Bart E Muhs
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2009-05-29
Journal Detail:
Title:  Journal of vascular surgery     Volume:  50     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-02     Completed Date:  2009-11-12     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  999-1004     Citation Subset:  IM    
Affiliation:
Section of Vascular Surgery, Department of Surgery at Yale University School of Medicine, New Haven, CT 06510, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Aortic Diseases / complications,  mortality,  surgery*
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects,  instrumentation,  mortality
Bronchial Fistula / complications,  mortality,  surgery*
Emergency Treatment
Esophageal Fistula / complications,  mortality,  surgery*
Esophagectomy
Esophagostomy
Europe
Female
Hematemesis / etiology,  surgery
Hemoptysis / etiology,  surgery
Hemostatic Techniques* / adverse effects,  instrumentation,  mortality
Hospital Mortality
Humans
Jejunostomy
Kaplan-Meier Estimate
Male
Middle Aged
Reoperation
Retrospective Studies
Shock, Hemorrhagic / etiology,  surgery
Stents
Time Factors
Treatment Outcome
Vascular Fistula / complications,  mortality,  surgery*
Comments/Corrections
Comment In:
J Vasc Surg. 2009 Nov;50(5):1004-5   [PMID:  19878782 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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