Abstract
Background
Aortoesophageal fistula (AEF) is a life-threatening late complication that can occur after thoracic endovascular aortic repair (TEVAR). More data are required to identify the optimal treatment strategy for AEF developed after TEVAR. The aim of this study was to clarify the current status of surgical treatments for AEF developed after TEVAR and the outcomes of these treatments.
Methods
The Japan Esophageal Society conducted a questionnaire survey targeting authorized or semi-authorized institutes at Authorized Institutes for Board Certified Esophageal Surgeons. Thirty-nine patients with AEF developed after TEVAR were identified from 15 institutes. Data on patient demographics, treatment performed, and survival rate were obtained by the questionnaire. The Kaplan–Meier method was used for survival analysis and differences in the survival rates.
Results
Esophagectomy and aortic replacement were performed in 32 and 22 patients, respectively, and 22 underwent both procedures. Postoperative complications were observed in 24 patients (75.0%). Complications with Clavien–Dindo Grade III or higher were observed in 53.1% of patients. Operative and hospital mortality rates were 3.1% and 18.8%, respectively. The survival rate in patients who underwent esophagectomy was higher than in those who did not (P < 0.0001). The survival of patients who underwent both esophagectomy and aortic replacement was also higher than in those who did not (P < 0.0001).
Conclusion
Esophagectomy combined with aortic replacement can offer a long-term treatment strategy with higher survival rates in patients who develop AEF after TEVAR. Because of the high incidence of postoperative morbidity and mortality, these types of surgery should only be performed in centers with both experienced esophageal and cardiovascular surgical teams.
Similar content being viewed by others
References
Masuda M, Endo S, Natsugoe S, et al. Thoracic and cardiovascular surgery in Japan during 2015. Gen Thorac Cardiovasc Surg. 2018;66:581–615.
McNamara JJ, Pressler VM. Natural history of arteriosclerotic thoracic aortic aneurysms. Ann Thorac Surg. 1978;26:468–73.
Chiesa R, Melissano G, Marone EM, et al. Aorto-oesophageal and aortobronchial fistulae following thoracic endovascular aortic repair: a national survey. Eur J Vasc Endovasc Surg. 2010;39:273–9.
Isasti G, Gomez-Doblas JJ, Olalla E. Aortoesophageal fistula: an uncommon complication after stent-graft repair of an aortic thoracic aneurysm. Interact Cardiovasc Thorac Surg. 2009;9:683–4.
Topel I, Stehr A, Steinbauer MG, et al. Surgical strategy in aortoesophageal fistulae: endovascular stentgrafts and in situ repair of the aorta with cryopreserved homografts. Ann Surg. 2007;246:853–9.
Jonker FH, Schlosser FJ, Moll FL, et al. Outcomes of thoracic endovascular aortic repair for aortobronchial and aortoesophageal fistulas. J Endovasc Ther. 2009;16:428–40.
Jonker FH, Heijmen R, Trimarchi S, et al. Acute management of aortobronchial and aortoesophageal fistulas using thoracic endovascular aortic repair. J Vasc Surg. 2009;50:999–1004.
Kubota S, Shiiya N, Shingu Y, et al. Surgical strategy for aortoesophageal fistula in the endovascular era. Gen Thorac Cardiovasc Surg. 2013;61:560–4.
Hance KA, Hsu J, Eskew T, et al. Secondary aortoesophageal fistula after endoluminal exclusion because of thoracic aortic transection. J Vasc Surg. 2003;37:886–8.
Eggebrecht H, Mehta RH, Dechene A, et al. Aortoesophageal fistula after thoracic aortic stent-graft placement: a rare but catastrophic complication of a novel emerging technique. JACC Cardiovasc Interv. 2009;2:570–6.
Rawala MS, Badami V, Rizvi SB, et al. Aortoesophageal fistula: a fatal complication of thoracic endovascular aortic stent-graft placement. Am J Case Rep. 2018;19:1258–61.
Chiesa R, Melissano G, Marone EM, et al. Endovascular treatment of aortoesophageal and aortobronchial fistulae. J Vasc Surg. 2010;51:1195–202.
Danneels MI, Verhagen HJ, Teijink JA, et al. Endovascular repair for aorto-enteric fistula: a bridge too far or a bridge to surgery? Eur J Vasc Endovasc Surg. 2006;32:27–33.
Burks JA Jr, Faries PL, Gravereaux EC, et al. Endovascular repair of bleeding aortoenteric fistulas: a 5-year experience. J Vasc Surg. 2001;34:1055–9.
Sugimachi K, Kitamura M, Maekawa S, et al. Two-stage operation for poor-risk patients with carcinoma of the esophagus. J Surg Oncol. 1987;36:105–9.
Morita M, Nakanoko T, Kubo N, et al. Two-Stage Operation for High-Risk Patients with Thoracic Esophageal Cancer: an Old Operation Revisited. Ann Surg Oncol. 2011;18:2613–21.
Stein HJ, Bartels H, Siewert JR. Esophageal carcinoma: 2-stage operation for preventing mediastinitis in high risk patients. Chirurg. 2001;72:881–6.
Van Doorn RC, Reekers J, de Mol BA, et al. Aortoesophageal fistula secondary to mycotic thoracic aortic aneurysm: endovascular repair and transhiatal esophagectomy. J Endovasc Ther. 2002;9:212–7.
Mok VW, Ting AC, Law S, et al. Combined endovascular stent grafting and endoscopic injection of fibrin sealant for aortoenteric fistula complicating esophagectomy. J Vasc Surg. 2004;40:1234–7.
Kawamoto K, Sato M, Motoyoshi N, et al. Outcomes of staged surgical treatment strategy for aortoesophageal fistula. Gen Thorac Cardiovasc Surg. 2015;63:147–52.
Acknowledgements
The authors wish to thank all participating centers, specifically those who provided patient data: Masaki Ohi (Mie University, Mie); Yoshihiro Ohta (Tokyo Medical University, Tokyo); Yoshihiro Kakeji (Kobe University, Hyogo); Hiroyuki Kitagawa (Kochi University, Kochi); Koji Kono (Fukushima Medical University, Fukushima); Toshiaki Shichinohe (Hokkaido University, Hokkaido); Shinsuke Takeno (Miyazaki University, Miyazaki); Akira Tangoku (Tokushima University, Tokushima); Masanobu Nakajima (Dokkyo Medical University, Tochigi); Kousuke Narumiya (Tokyo Women’s Medical University, Tokyo); Hideo Baba (Kumamoto University, Kumamoto); Yoichi Hamai (Hiroshima University, Hiroshima); Hitoshi Fujiwara (Kyoto Prefectural University of Medicine, Kyoto); Hisahiro Matsubara (Chiba University, Chiba); and Satoru Motoyama (Akita University, Akita).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical Statement
All procedures were in accordance with the ethical standards of the responsible committee on human experimentation and comply with the Helsinki Declaration of 1964 and all subsequent versions.
Conflict of interest
Watanabe M, Sato M, Fukuchi M, Kato H, and Matsubara H declare that they have no conflicts of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Watanabe, M., Sato, M., Fukuchi, M. et al. Treatment of aortoesophageal fistula developed after thoracic endovascular aortic repair: a questionnaire survey study. Esophagus 17, 81–86 (2020). https://doi.org/10.1007/s10388-019-00683-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10388-019-00683-y