Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection

The Korean Journal of Thoracic and Cardiovascular Surgery
Jae-Hong LeeKyung-Hwan Kim

Abstract

A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient's postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up.

References

Apr 6, 2000·The Annals of Thoracic Surgery·M J ReardonH J Safi
Mar 22, 2008·The Annals of Thoracic Surgery·Shunsuke KawamotoKoichi Tabayashi
Feb 22, 2012·Interactive Cardiovascular and Thoracic Surgery·Aya SaitoMinoru Ono
Oct 13, 2012·The Journal of Thoracic and Cardiovascular Surgery·Kazuya KobayashiToshiaki Shichinohe
Jun 20, 2013·The Journal of Thoracic and Cardiovascular Surgery·Mariangela De MasiPhilippe Piquet
Nov 10, 2013·Journal of Vascular Surgery·Ludovic CanaudMatt Thompson
Mar 13, 2014·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Yutaka OkitaHiroya Kano

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Citations

Jul 1, 2020·Angiologii︠a︡ i sosudistai︠a︡ khirurgii︠a︡ = Angiology and vascular surgery·V V ShlominN O Dmitrievskaia
Oct 6, 2020·Gastroenterology Research and Practice·Shan LiJie Zhang

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Methods Mentioned

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dissection

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