Aortoesophageal fistula secondary to thoracic endovascular aortic repair of a descending aortic aneurysm rupture

Heart Surg Forum. 2011 Aug;14(4):E249-51. doi: 10.1532/HSF98.20101179.

Abstract

Purpose: We present the case of a patient who developed an aortoesophageal fistula (AEF) 4 years after thoracic endovascular aortic repair (TEVAR) of a descending thoracic aortic aneurysm rupture.

Case report: A 60-year-old female patient underwent emergency stent graft placement in December 2006 because of rupture of a distal descending aortic aneurysm. The patient was discharged uneventfully. Four years later, the patient was readmitted because of recurrent hematemesis, weight loss, and malaise. A computed tomography scan and an upper gastrointestinal system (GIS) endoscopy examination revealed an AEF located at the midportion of the esophagus and at the caudal end of the stent graft. An emergency stent graft was re-replaced into the previous graft. The patient died from hemorrhagic shock due to massive GIS bleeding while she was being prepared for secondary major esophageal surgery.

Conclusion: AEF is a catastrophic complication of TEVAR. Conservative treatment is often associated with fatal results. If possible, these patients should be treated with secondary major surgical procedures.

Publication types

  • Case Reports

MeSH terms

  • Aneurysm, Ruptured / diagnosis
  • Aneurysm, Ruptured / surgery*
  • Aorta, Thoracic*
  • Aortic Aneurysm, Thoracic / diagnosis
  • Aortic Aneurysm, Thoracic / surgery*
  • Diagnosis, Differential
  • Endoscopy, Gastrointestinal
  • Esophageal Fistula / diagnosis
  • Esophageal Fistula / etiology*
  • Esophageal Fistula / surgery
  • Fatal Outcome
  • Female
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Postoperative Complications
  • Tomography, X-Ray Computed
  • Vascular Fistula / diagnosis
  • Vascular Fistula / etiology*
  • Vascular Fistula / surgery
  • Vascular Surgical Procedures / adverse effects*
  • Vascular Surgical Procedures / methods