Akademik Veri Yönetim Sistemi
24th Congress of Asian Society of Vascular Surgery, Antalya, Türkiye, 30 Kasım - 03 Aralık 2023, ss.4
INTRODUCTION: Despite its rarity, aortoesophageal fistula (AEF) is clinically challenging to manage, particularly because of its poor prognosis. This condition can be seen in aneurysms or secondary to malignancy and foreign bodies. Although surgical intervention is the main approach for AEF, such invasive procedures may further complicate the process due to the low general conditions of many patients. As a current approach, clinicians may prioritize thoracic endovascular aortic repair (TEVAR), a less invasive technique, in such cases. In this article, we report on the management of TEVAR in the case of AEF after oesophageal stenting.
CASE: A 62-year-old male, 60-pack/year smoker with known chronic renal failure, chronic obstructive pulmonary disease and oesophagal squamous cell malignancy, developed a benign stricture in the distal oesophagus after 20 sessions of radiotherapy. The patient, who had difficulty in food intake and vomiting, underwent oesophagal stenting twice. One week after the last stenting, he presented to the emergency unit with hematemesis and general condition disorder. The patient is consulted to our department and a contrast-enhanced computed tomography (CT) is planned.
METHODS: When the patient was admitted to the emergency department, the hemogram revealed a haemoglobin value of 3.8 g/dl and a haematocrit of 12%. The patient underwent contrast-enhanced CT, 2 previously applied esophageal stents were seen side by side and which revealed extravasation from a 5 mm diameter fistula in the thoracic aorta adjacent to the oesophagal stent into the intraesophageal space, and TEVAR was decided to be performed.
RESULTS: Perop contrast-enhanced imaging performed after TEVAR showed successful closure of the AEF and no extravasation was observed. No haemoglobin decrease was observed in postop intensive care unit follow-up and the patient was followed up under broad-spectrum meropenem and vancomycin treatment. Postoperative follow-up revealed tracheoesophageal fistula and the patient was referred to the relevant department.
CONCLUSIONS: Successful management of AEF is rare. Patients with haematemesis associated with oesophageal cancer or stenting should be checked by timely contrast-enhanced CT imaging. In this way, timely diagnosis of AEF is very important. In our case, TEVAR was found to be an effective approach for AEF caused by oesophageal cancer.
Keywords: Aortoeosophageal Fistula, TEVAR, Oesophageal Cancer, Oesophageal Stent, Fistula