Document Detail


Combined endovascular and surgical treatment of primary aortoesophageal fistula.
MedLine Citation:
PMID:  21224956     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Primary aortoesophageal fistula is a rare cause of massive upper gastrointestinal bleeding. Conservative treatment of aortoesophageal fistula results in a 60% in-hospital mortality rate with no late survival, and conventional surgical treatment has a reported in-hospital mortality rate that approaches 40%. Thoracic endovascular aortic repair is an innovative and less invasive technique for the treatment of aortoesophageal fistula. It enables the rapid control of aortic bleeding and prevents fatal early exsanguination. However, the technique does not repair the esophagus, and there remains a substantial risk of mediastinitis and infection of the stent-graft. Herein, we report the cases of 2 patients in whom we used a combined treatment: thoracic endovascular aortic repair and delayed surgical repair of the esophagus. The esophageal repair involved direct suture of the esophageal wall and reinforcement with an intercostal muscle flap. Early follow-up evaluations suggest that our treatment of both patients was successful. We discuss the advantages and limitations of our technical choices and briefly review the pertinent medical literature.
Authors:
Enrico Maria Marone; Giovanni Coppi; Andrea Kahlberg; Yamume Tshomba; Roberto Chiesa
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital     Volume:  37     ISSN:  1526-6702     ISO Abbreviation:  Tex Heart Inst J     Publication Date:  2010  
Date Detail:
Created Date:  2011-01-12     Completed Date:  2011-04-22     Revised Date:  2013-07-02    
Medline Journal Info:
Nlm Unique ID:  8214622     Medline TA:  Tex Heart Inst J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  722-4     Citation Subset:  IM    
Affiliation:
Department of Vascular Surgery, Vita-Salute University, Scientific Institute H. San Raffaele, 20132 Milan, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aorta, Thoracic / radiography,  surgery*
Aortic Diseases / complications,  radiography,  surgery*
Aortography / methods
Blood Vessel Prosthesis Implantation*
Endovascular Procedures*
Esophageal Fistula / complications,  radiography,  surgery*
Gastrointestinal Hemorrhage / etiology,  surgery
Humans
Male
Middle Aged
Surgical Flaps
Suture Techniques
Thoracic Surgical Procedures*
Thoracotomy
Tomography, X-Ray Computed
Treatment Outcome
Vascular Fistula / complications,  radiography,  surgery*
Comments/Corrections

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