Two-stage surgical strategy for aortoesophageal fistula: Emergent thoracic endovascular aortic repair followed by definitive open aortic and esophageal reconstruction

摘要

Aortoesophageal fistula (AEF) is a rare complication, and is generally fatal without surgical intervention. Primary causes for AEF formation include foreign body ingestion, ruptured thoracic aortic aneurysms, endograft stenting of the thoracic aorta, advanced esophageal cancer, and surgical procedures involving the esophagus. Even though there are reports of thoracic endovascular stenting for the treatment of aortoesophageal fistula with early success, late failure and mortality is common. The general consensus challenges the concept of deployment of an endograft prosthesis in the setting of an infected field. We report a case of AEF with gross mediastinal contamination treated in a planned 2-stage approach: initial endovascular stenting of the thoracic aorta as a bridge for patient stabilization, followed by definitive open surgical repair (ie, replacement of the endograft with an aortic homograft, esophageal repair, and wide mediastinal drainage).