Combined Endovascular and Endoscopic Management of a Secondary Aortoesophageal Fistula after Open Surgical Aortic Repair in a Giant Descending Thoracic Aortic Pseudoaneurysm: Case Report and Review of Literature
Abstract
:1. Introduction
2. Case Presentation
3. Review and Discussion
3.1. Etiology and Pathogenesis
- (1)
- (2)
- The presence and resorption of periaortic hematoma trigger an aggressive regional inflammatory response, changing the histopathological structure of the esophageal wall. This is followed by the occurrence of adhesions, tissue necrosis, erosion, and fistulous communications [6,9]. Chiesa R and his colleagues admit that these modifications (local inflammatory response and surrounding compression) are not always completely ameliorated, even after TEVAR; thus, they are involved in the development of late fistulization [6];
- (3)
- Mechanical damage in the affected region is caused by continuous arterial pulsation of a “modified” aortic wall. And when we say “modified” aortic wall, we mean either the synthetic material used for aortic replacement in surgical approaches (Ex. Dacron) or the rigidity of the aorta and the geometrical changes induced by the endoprostheses. (Radial force of the stent graft against the native wall) [1,10].
- (4)
3.2. Clinical Presentation
3.3. Imagistic Evaluation
3.4. Treatment Strategies
4. Conclusions
Author Contributions
Funding
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Authors | Year | Country | Number of Patients | Age (Years) | Type of AEF | Management of Aortic Lesion | Treatment of AEF | Follow-Up | Mortality |
---|---|---|---|---|---|---|---|---|---|
Enomoto et al. [11] | 2020 | Japan | 4 | 80 ± 8 | Secondary | 1 case of TEVAR and 1 case of SAR | Esophagectomy and esophageal reconstruction | NS | 25% |
Chiba et al. [1] | 2013 | Japan | 1 | 70 | Secondary | SAR | Omental implantation | 10 months | 0% |
Jonker et al. [10] | 2009 | Netherlands | 43 | 62 ± 2.5 | NS | TEVAR | Surgical | 5 months | 32.5% |
Monteiro [2] | 2020 | Portugal | 1 | 41 | Primary | TEVAR | Endoscopic clips | Ns | Ns |
Canaud et al. [12] | 2014 | England | 72 | 59.2 | 26 Primary 46 secondary | TEVAR | Surgical | 7.4 months | 40.2% |
Yamazato et al. [7] | 2017 | Japan | 18 | 67.2 ± 10.4 | Secondary | 3 TEVAR 3 bridge TEVAR to open surgery 12 SAR | Surgical Resection and omental flap | 60 months | 57.6% |
Rodrigues-Pinto [13] | 2015 | Portugal | 1 | 63 | Secondary | TEVAR | Esophageal Stent | NS | NS |
Wu et al. [3] | 2022 | China | 1 | 58 | Secondary | TEVAR | Esophageal Stent | 6 months | 0% |
Furui et al. [8] | 2021 | Japan | 1 | 72 | Secondary | TEVAR | Surgical, muscle flap and Esophageal Stent | NS | NS |
Yuhara [15] | 2017 | Japan | 1 | 77 | Secondary | SAR | Omental flap | 36 months | 0% |
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Stiru, O.; Nayyerani, R.; Robu, M.; Geana, R.C.; Dragulescu, P.R.; Blibie, O.A.; Bubenek-Turconi, S.-I.; Iliescu, V.A.; Parasca, C. Combined Endovascular and Endoscopic Management of a Secondary Aortoesophageal Fistula after Open Surgical Aortic Repair in a Giant Descending Thoracic Aortic Pseudoaneurysm: Case Report and Review of Literature. J. Pers. Med. 2024, 14, 625. https://doi.org/10.3390/jpm14060625
Stiru O, Nayyerani R, Robu M, Geana RC, Dragulescu PR, Blibie OA, Bubenek-Turconi S-I, Iliescu VA, Parasca C. Combined Endovascular and Endoscopic Management of a Secondary Aortoesophageal Fistula after Open Surgical Aortic Repair in a Giant Descending Thoracic Aortic Pseudoaneurysm: Case Report and Review of Literature. Journal of Personalized Medicine. 2024; 14(6):625. https://doi.org/10.3390/jpm14060625
Chicago/Turabian StyleStiru, Ovidiu, Reza Nayyerani, Mircea Robu, Roxana Carmen Geana, Petru Razvan Dragulescu, Oana Andreea Blibie, Serban-Ion Bubenek-Turconi, Vlad Anton Iliescu, and Catalina Parasca. 2024. "Combined Endovascular and Endoscopic Management of a Secondary Aortoesophageal Fistula after Open Surgical Aortic Repair in a Giant Descending Thoracic Aortic Pseudoaneurysm: Case Report and Review of Literature" Journal of Personalized Medicine 14, no. 6: 625. https://doi.org/10.3390/jpm14060625