Surgical Treatment for Secondary Aortoesophageal Fistula
BackgroundAortoesophageal fistula(AEF) is a relatively rare condition that is often life-threatening.Secondary AEF is a complication ofprevious surgery,whichcan be more critical and challenging than primary AEF.The number of secondary AEF is increasing due to increase in the number of thoracic endovascular aortic repair (TEVAR). Although TEVAR has become a successful alternative surgical strategy forthoracic aortic aneurysms, secondary AEF after TEVAR might be critical than other secondary AEF
... ther secondary AEF because of severe adhesion between the esophagus and residual thoracic aortic wall.Methods This study analyzedsixpatients with secondaryAEFwho were treated at TokyoMedical University Hospitalbetween 2011 and 2016. These participants includedfour patients who had undergone TEVAR and two who had undergone total arch replacement.ResultsAlthough they were subsequently hospitalized for a long period, open surgical repair was completed intwo patients who had undergonetotal archreplacement.TEVAR alone was performedin two patients who had undergone TEVAR and they were discharged without major complications shortly. Combined repair of TEVARas a bridge to open surgery was plannedfor two patients who had undergone TEVAR. However, reconstruction of the aorta and esophagus could not be completed in these patients due to severe adhesions, and they died during hospitalization. ConclusionsDefinitive open repair wassuccessfully performed in patients with secondary AEF after total arch replacement. However, in the patients with secondaryAEF after TEVAR, severe adhesion between the aorta and esophagus led to difficulty in performing a successful definitive open repair.The strategy for secondary AEF should, therefore, be decided considering the etiology of secondary AEF. In secondary AEF after TEVAR, palliative treatment using TEVAR without reconstruction of aorta and esophagus should be considered.