Case Report AbstractAortoesophageal Fistula Secondary to Placement of an Esophageal Stent: Emergent Treatment with Cyanoacrylate and Endovascular Stent Graft
Section snippets
Case Report
A 53-year-old man with lung cancer was admitted with dysphagia. He had undergone radiation and chemotherapy 8 months earlier. Endoscopy revealed extrinsic esophageal compression, and metastatic lymphadenopathy compressing the esophagus and left atrium was observed on computed tomography (CT) scanning. An 18-mm-diameter, 10-cm-long, retrievable covered esophageal stent (CHOOSTENT; M.I. Tech, Seoul, Korea) (Fig. 1A) was placed in the mid-esophagus by an endoscopist.
The patient was admitted with
Discussion
An AEF is a life-threatening condition due to massive bleeding, and it requires prompt recognition and management. An AEF is usually caused by descending thoracic aortic diseases, including aneurysm, foreign body ingestion, and esophageal diseases such as esophageal cancer or ulcers. Among them, thoracic aortic aneurysm is responsible for approximately two-thirds of AEFs. Rapid diagnosis and repair to reduce morbidity and mortality are important in the management of AEFs. Previous reports
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Cited by (24)
Aortoesophageal fistula after laparoscopic total gastrectomy
2022, Cirugia EspanolaGreat vessel injury in thoracic surgery
2015, Thoracic Surgery ClinicsCitation Excerpt :Aortic erosion and bleeding have been reported in the setting of anastomotic leaks and associated infection, as well as after placement of endoluminal stents for treatment of these complications. Development of aortoesophageal or aortogastric fistulae is a feared and well-known complication involving a high operative mortality.118–122 Endovascular stent graft repair of aortic complications due to esophagectomy have been reported, both in the immediate operative setting and in the postoperative period, often involving infected mediastinal fields with anastomotic leaks or fistulizing complications.123–126
Thoracic endovascular aortic repair in management of aortoesophageal fistulas
2014, Journal of Vascular SurgeryCitation Excerpt :All results with P < .05 were considered statistically significant. Fifty-five articles were integrated after a literature search identified 72 patients treated by TEVAR for AEFs.2-56 Patient demographics, presenting features, and comorbidities are shown in Tables I and II.
Cyanoacrylate applications in the GI tract
2013, Gastrointestinal EndoscopyCitation Excerpt :There are, however, no controlled trials. Three case reports describe the use of enbucrilate injection as an emergency measure to halt bleeding from an aortoenteric fistula, allowing the patient to be stabilized for placement of an endovascular graft as definitive therapy.95-97 A similar case report describes success in treating a bleeding azygos-esophageal fistula.98
Lethal aorto-oesophageal fistula-Characteristic features and aetiology
2013, Journal of Forensic and Legal MedicineCitation Excerpt :Leakage of oesophageal and gastric contents results in mediastinal abscess formation.22 In an attempt to avoid this complication, endoscopic stent repair was introduced; however, this may also result in aorto-oesophageal fistulae due to pressure on the adjacent aorta with necrosis of the vessel wall.22,23 Less commonly, erosions or sinuses from grafts may extend out from the oesophagus without communicating with the lumen of the aorta and so do not cause massive haemorrhage; the presentation instead involves mediastinitis and graft infection.6
Risk of stent-related aortic erosion after endoscopic stent insertion for intrathoracic anastomotic leaks after esophagectomy
2011, Annals of Thoracic SurgeryCitation Excerpt :These preconditions have to be verified by endoscopy with direct visualization of the anastomosis before stent insertion can be considered [10–12]. At the same time, first reports of stent-related vascular erosions were published [18–23]. These reports are mostly on patients with benign or malignant stenosis of the esophagus who received endoscopic stent insertion in palliative intention to reopen passage for oral intake.