Aortoesophageal fistula as a complication of thoracic aorta stent graft implantation: two cases and literature review
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.
Keywords: computer tomographyaortoesophageal fistulaaortobronchial fistula esophagogastroduodenoscopythoracic endovascular aortic repair
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