ISMICS 2023 Annual Meeting

Definitive Endovascular Treatment of Aortoesophageal Fistula in a Young Patient

BACKGROUND

Aortoesophageal fistula (AEF)

-Rare and highly fatal disease

-HIGH operative morbidity and mortality

Several treatment options for AEF

-Surgical replacement with staged esophageal reconstruction

-Endovascular treatment and staged open surgical repair

-Evidence-based guidelines could not be established due to the rarity of the disease.

CASE REPORT

Patient

-A 27-year-old female who had no underlying disease

-No history of foreign body ingestion or major trauma

Chief complaint

-Abrupt hematemesis with hypovolemic shock

Emergent endoscopy for the upper gastrointestinal tract

-Extensive hematoma in the esophagus without evidence of ongoing bleeding (Figure 1A)

-A pulsatile mass-like lesion compressing the esophagus at 24-33 cm from the incisor (Figure 1B)

CT scans

-A 6.6 ´ 5.0 cm outpouching structure from the descending thoracic aorta, compressing the adjacent esophagus

Diagnosis

-AEF with an outpouching aneurysm at the descending thoracic aorta

Treatments

-Emergent zone 3 TEVAR under local anesthesia

-Primary repair of the ruptured esophagus with evacuation of the hematoma
(8 days after TEVAR)

HOSPITAL COURSE AND FOLLOW-UP

Hospital course

-No acute complication

-Esophagograms (the 11th postoperative day): no contrast leak

-Oral diet

2-year follow-up

- No endoleak, no relapse of the infection

CONCLUSION

Definitive TEVAR for AEF

-Should be very cautiously performed in carefully selected patients

-Life-long follow-up

Definitive Endovascular Treatment Of Aortoesophageal Fistula In A Young Patient