open access

Vol 26, No 2 (2020)
Case reports
Published online: 2020-07-29
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Aortoesophageal fistula as a complication of thoracic aorta stent graft implantation: two cases and literature review

Olga Basiak, Laretta Grabowska-Derlatka, Tomasz Jakimowicz, Olgierd Rowiński
DOI: 10.5603/AA.2020.0012
·
Acta Angiologica 2020;26(2):76-80.

open access

Vol 26, No 2 (2020)
Case reports
Published online: 2020-07-29

Abstract

Thoracic endovascular aortic repair (TEVAR) is a method of choice in the treatment of thoracic aorta aneurysms
and dissections. In case of a thoracoabdominal aneurysm, endovascular treatment is also being chosen more
often, especially in patients with multimorbidity. Despite better results and less invasiveness in comparison to
classic open surgery, endovascular treatment is also associated with complications. One of the rarer and usually
fatal complications are aortoesophageal fistula (AEF). We present two cases, in which TEVAR complication
was AEF. Case 1 was an 87-year-old woman with a history of TEVAR 5 years earlier, who presented increased
inflammation parameters, massive gastrointestinal bleeding, and progressive anemia. Case 2 was a 66-year-old
woman with a history of TEVAR 6 months earlier, who on admission presented medium increased inflammatory
markers and anemia. None of the patients was qualified for surgical treatment. Both patient 1 and patient 2
died during hospitalization. Diagnostic imaging plays a key role in the diagnosis of AEF. CT angiography performed
in patients with AEF can show the presence of gas in the sac of aneurysm as a result of infection, a defect in
the aortic wall, or thickened esophagus with fluid level. CT angiography of the aorta combined with esophagogastroduodenoscopy
(EGD) and contrast-enhanced X-ray examination of the gastrointestinal tract, enables
to confirm or exclude the diagnosis of AEF. Atypical clinical feature and increased parameters of inflammation
in patients with the history of TEVAR should always suggest the presence of AEF.

Abstract

Thoracic endovascular aortic repair (TEVAR) is a method of choice in the treatment of thoracic aorta aneurysms
and dissections. In case of a thoracoabdominal aneurysm, endovascular treatment is also being chosen more
often, especially in patients with multimorbidity. Despite better results and less invasiveness in comparison to
classic open surgery, endovascular treatment is also associated with complications. One of the rarer and usually
fatal complications are aortoesophageal fistula (AEF). We present two cases, in which TEVAR complication
was AEF. Case 1 was an 87-year-old woman with a history of TEVAR 5 years earlier, who presented increased
inflammation parameters, massive gastrointestinal bleeding, and progressive anemia. Case 2 was a 66-year-old
woman with a history of TEVAR 6 months earlier, who on admission presented medium increased inflammatory
markers and anemia. None of the patients was qualified for surgical treatment. Both patient 1 and patient 2
died during hospitalization. Diagnostic imaging plays a key role in the diagnosis of AEF. CT angiography performed
in patients with AEF can show the presence of gas in the sac of aneurysm as a result of infection, a defect in
the aortic wall, or thickened esophagus with fluid level. CT angiography of the aorta combined with esophagogastroduodenoscopy
(EGD) and contrast-enhanced X-ray examination of the gastrointestinal tract, enables
to confirm or exclude the diagnosis of AEF. Atypical clinical feature and increased parameters of inflammation
in patients with the history of TEVAR should always suggest the presence of AEF.

Get Citation

Keywords

computer tomography, aortoesophageal fistula, aortobronchial fistula esophagogastroduodenoscopy, thoracic endovascular aortic repair

About this article
Title

Aortoesophageal fistula as a complication of thoracic aorta stent graft implantation: two cases and literature review

Journal

Acta Angiologica

Issue

Vol 26, No 2 (2020)

Pages

76-80

Published online

2020-07-29

DOI

10.5603/AA.2020.0012

Bibliographic record

Acta Angiologica 2020;26(2):76-80.

Keywords

computer tomography
aortoesophageal fistula
aortobronchial fistula esophagogastroduodenoscopy
thoracic endovascular aortic repair

Authors

Olga Basiak
Laretta Grabowska-Derlatka
Tomasz Jakimowicz
Olgierd Rowiński

References (11)
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  2. Eggebrecht H, Mehta R, Dechene A, et al. Aortoesophageal fistula after thoracic aortic stent-graft placement. JACC: Cardiovascular Interventions. 2009; 2(6): 570–576.
  3. Nazarewicz GV, Jain R. Upper gastrointestinal bleeding caused by aortoesophageal fistula. Clin Gastroenterol Hepatol. 2016; 14(12): A22.
  4. Karb DB, Mansoor E, Sullivan J, et al. Atypical presentation of aortoesophageal fistula without hemorrhage. ACG Case Rep J. 2019; 6(2): e00004.
  5. Rawala MS, Badami V, Rizvi SB, et al. Aortoesophageal fistula: a fatal complication of thoracic endovascular aortic stent-graft placement. Am J Case Rep. 2018; 19: 1258–1261.
  6. Akin M, Yalcinkaya T, Alkan E, et al. A cause of mortal massive upper gastrointestinal bleeding: aortoesophageal fistula. Med Arch. 2016; 70(1): 79–81.
  7. Tao M, Shlomovitz E, Darling G, et al. Secondary aorto-esophageal fistula after thoracic aortic aneurysm endovascular repair treated by covered esophageal stenting. World J Clin Cases. 2016; 4(8): 233–237.
  8. Akaraviputh T, Sriprayoon T, Prachayakul V, et al. Endoscopic diagnosis of secondary aortoesophageal fistula. Endoscopy. 2008; 40 Suppl 2: E90.
  9. Hance KA, Hsu J, Eskew T, et al. Secondary aortoesophageal fistula after endoluminal exclusion because of thoracic aortic transection. J Vasc Surg. 2003; 37(4): 886–888.
  10. Leung AD, Yamanouchi D. Case report of retrograde in situ fenestration of the thoracic stent graft with reentry device in a patient with aortobronchial fistula. Medicine (Baltimore). 2018; 97(24): e11050.
  11. Mosquera VX, Marini M, Pombo-Felipe F, et al. Predictors of outcome and different management of aortobronchial and aortoesophageal fistulas. J Thorac Cardiovasc Surg. 2014; 148(6): 3020–6.e1.

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