Open surgical treatment of secondary aorto-esophageal and aortobronchial fistula after thoracic endovascular aortic repair and esophagocoloplasty in a second procedure.

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Open surgical treatment of secondary aorto-esophageal and aortobronchial fistula after thoracic endovascular aortic repair and esophagocoloplasty in a second procedure.

Ann Vasc Surg. 2017 May 11;:

Authors: Sladojevic M, Bjelovic M, Ilic N, Mutavdzic P, Koncar I, Dragas M, Davidovic L

Abstract
INTRODUCTION: Aorto-esophageal (AEF) and aortobronchial fistula (ABF) after TEVAR are rare complications with catastrophic consequences without treatment. In this case report we presented a patient with AEF and ABF after TEVAR successfully treated with endograft explantation and replaced by Dacron graft followed by esophagectomy and left principal bronchus repairing.
CASE REPORT: We report a patient with AEF and ABF after TEVAR who was evaluated due to dysphagia and chest pain followed by hematemesis and hemoptysis. Endoscopic examination revealed lesion of the esophageal wall with chronic abscess formation and stent-graft protrusion into the cavity. Patient was operated on with extracorporeal circulation. AEF and ABF were confirmed intraoperatively. Endograft was explanted and in situ reconstruction of thoracic aorta was carry out with tubular Dacron 22mm prosthesis wrapped with omental flap. After aortic reconstruction, esophageal mucosal stripping was performed with cervical esophagostomy, pyloromyotomy and Stamm-Kader gastrostomy for nutrition. In addition, omentoplasty of the deffect in the left principal bronchus were performed. To re-establish peroral food intake esophagocoloplasty was carried out eight months after previous surgery utilizing transversosplenic segmet of the colon and retrosternal rout.
CONCLUSION: In very selective cases stent-graft explantation and in situ reconstruction with Dacron graft covered by omental flap followed by esophagectomy and bronchus repairing permits adequate debridement reducing the risk of mediastinitis and graft infection and allows a safe esophageal reconstruction in a second procedure.

PMID: 28502887 [PubMed - as supplied by publisher]

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