Aortic Stent Graft and Esophageal Covered Stent for Aortoesophageal Fistula Associated with Locally Advanced Unresectable Esophageal Cancer

Abstract

Chemoradiotherapy can improve prognosis and is the beneficial standard treatment currently available for locally advanced unresectable esophageal cancer, but it can also be associated with esophageal fistula formation to adjacent organs, and may cause fatal bleeding subsequent to the aortoesophageal fistula (AEF) especially when the cancer involves the aorta. We encountered a case of AEF with esophageal cancer undergoing chemoradiotherapy, which was treated using aortic stent grafts. A 67-year-old man with dysphagia was given a diagnosis of locally advanced unresectable esophageal cancer directly invading into the aorta. The patient was treated with definitive chemoradiotherapy and obtained a partial response. He experienced shock due to hematemesis and AEF was diagnosed. Open thoracic surgery was not considered to be feasible in patients with unresectable cancer, therefore aortic stent grafting was planned. The patient tolerated the procedure well and hemostasis was achieved. His general condition dramatically improved and he became stable. An additional esophageal covered stent was applied for esophageal stenosis due to compression by the aortic stent grafts. The patient was able to eat well and was discharged, and followed an uneventful course without hematemesis or dysphagia until he died of cachexia due to progression of esophageal cancer on the 115th postoperative day under home palliative care. AEF remains as a life-threatening condition with a high rate of morbidity and mortality but can be successfully treated using aortic stent grafts, which can prevent sudden death due to fatal bleeding and aortic rupture. Aortic stent grafting is a less invasive and effective palliative treatment for AEF and may be a feasible alternative to open thoracic surgery.