Successful Endovascular Stent-graft Treatment for Two Cases of Aortoesophageal Fistula Secondary to Thoracic Aortic Aneurysm

Abstract

An aortoesophageal fistula is a rare but fatal condition. There is no established treatment for the disease to date. We experienced two cases of aortoesophageal fistula successfully treated by endovascular stent-grafting. Case 1 involved a 69-year-old woman who was brought into our hospital by ambulance because of fever, back pain, and massive haematemesis. Case 2 involved a 67-year-old man who was brought into our hospital by ambulance because of dysphagia and massive haematemesis. In both cases, contrast-enhanced thoracic computed tomographic findings confirmed the diagnosis of descending aortoesophageal fistula. Urgent endovascular stent-graft placement was conducted on the day of hospitalization. After stent-graft placement, in case 1, we attempted primary closure of the esophageal fistula, its covering using a latissimus dorsi musculocutaneous flap and creation of jejunal fistula, but urgent esophagectomy was necessary 7 days later because of leakage of the closure site. Esophageal reconstruction was performed 2 months after esophagectomy as the second step approach. In case 2, we performed esophagectomy and esophageal reconstruction in a one-step approach. In both patients, 3-year follow-up studies revealed no signs of infection of the grafts.

Conclusion : Our experiences suggest that endovascular stent-graft placement is useful for bleeding control from aortoesophageal fistula and that esophagectomy followed by esophageal reconstruction provides good infection control.