A Staged Surgical Treatment Strategy for Aortoesophageal Fistula

Abstract

Objectives: The aims of this study are to evaluate our current surgical strategy for AEF and to provide insight to further improve the prognosis of such a devastating condition. Methods and Results: Between 2007 and 2015, we retrospectively reviewed clinical charts of five patients requiring surgical treatment for aortoesophageal fistula (AEF) in Tenri Hospital. Two cases were primary and three were secondary. Initially, subtotal esophagectomy and complete debridement of infected mediastinal tissue were performed. Then, the patients underwent in situ aortic replacement with rifampicin-bonded Dacron grafts in a controlled infection. Esophageal reconstruction was planned following general physical status improvement after 2–5 months. The completion of the staged strategy achieving successful esophageal reconstruction was possible in three patients. Conclusions: The staged surgical treatment strategy for AEF consisted of subtotal esophagectomy and subsequent in situ reconstruction of the aorta with rifampicin-bonded gelatin-sealed Dacron graft. Avoiding delay in the diagnosis and initial treatment and resolving complications at each treatment step should further improve the treatment of AEF.