Secondary aorto-esophageal fistula treatment after endovascular thoracic aorta reconstruction

Authors: Bockeria L.A., Abdulgasanov R.A., Gasymov E.G., Stryukov R.E.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, 121552, Russian Federation

UDC: 616.132-007.281-036.11
DOI: https://doi.org/10.24022/1810-0694-2020-21-6-607-618

Cite as: Bockeria L.A., Abdulgasanov R.A., Gasymov E.G., Stryukov R.E. Secondary aorto-esophageal fistula treatment after endovascular thoracic aorta reconstruction. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2020; 21 (6): 607–18 (in Russ.). DOI: 10.24022/1810-0694-2020-21-6-607-618

Received / Accepted: 09.04.2020 / 12.04.2020

Keywords: aorto-esophageal fistula endovascular thoracic aorta reconstruction thoracic aorta aneurysm endoscopy surgery

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Abstract

Aorto-esophageal fistula (AEF) is rare, but life-threatening and hardly diagnosed complication. Despite of good shortterm results after thoracic endovascular aortic repair (TEVAR), wide spreading of this method leads to increase of AEF after TEVAR (post-TEVAR AEF). This review contains most optimal methods of diagnosis and treatment of this complication. Despite of precise triad of symptoms, including chest pain, hemoptysis following with large hematemesis, interval between them is unpredictable. Early diagnosis is very important, but there are lack of precise criteria for computer tomography and esophago-gastro-duodenoscopy. The formation of post-TEVAR AEF might be associated with the infection of micro-organisms with resistance against certain antibiotics. Recommended tactics includes TEVAR for bleeding control, following by radical debridement and open reconstruction of aorta/esophagus. Due to high mortality, it is recommended to consider individual conditions of patients, contraindications for surgery, size of the defect and etiology of AEF. Post-TEVAR AEF should be considered, if patient with previous TEVAR has this triad of symptoms. A registry and data base are needed for developing precise diagnosis and treatment strategy.

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About the authors

Leo A. Bockeria, Academician of Russian Academy of Sciences and Russian Academy of Medical Sciences, President of Center, ORCID
Ramiz A. Abdulgasanov, Dr. Med. Sc., Chief Researcher, ORCID
Ramiz A. Abdulgasanov, Dr. Med. Sc., Chief Researcher, ORCID
Roman E. Stryukov, Resident, ORCID

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Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery

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