Zusammenfassung
Die aortoösophageale Fistel nimmt einen Anteil unter 10 % an allen aortoenterischen Fisteln ein. Sie stellt eine seltene, jedoch häufig letal verlaufende Ursache einer oberen gastrointestinalen Blutung dar. Die aortoösophageale Fistel ist durch eine abnorme Verbindung zwischen der Aorta und dem Ösophagus charakterisiert. Die Erkrankung wird in eine primäre und eine sekundäre Form unterteilt. Von einer sekundären Fistel wird nach vorausgegangener Intervention oder Operation gesprochen. Seit der 1969 erstmals beschriebenen erfolgreichen chirurgischen Therapie des Krankheitsbildes sind in den letzten zwei Jahrzehnten vermehrt endovaskuläre Fallberichte über erfolgreiche Interventionen in der Literatur erschienen. Als erste Option nach einer möglichen endoskopischen Blutstillung im Ösophagus mittels Sengstaken-Blakemore-Sonde, Dilatationsballon oder Ösophagusstent ist das anschließende zeitnahe Stenting der Aorta als Bridging-Verfahren indiziert. Nach dem Stenting der Aorta ist eine Langzeitantibiose anzusetzen und die chirurgische Versorgung des Ösophagus im Intervall anzustreben.
Summary
Aorto-Esophageal fistulas constitute less than 10 % of all aorto-enteric communications. They are rare but life-threatening causes of upper gastrointestinal bleeding. Aorto-Esophageal fistulas are characterized by an abnormal communication between the aorta and the esophagus. The disease is classified as being either primary or secondary. A secondary Aorto-Esophageal fistula is defined as incidence after operation or intervention. Since the first successful operation 1969 several case reports described in the past two decades the endovascular treatment of this disorder. First option after possible endoscopic hemostasis of the esophageal bleeding is prompt placement of an endovascular aortic stent graft as bridging solution. Afterwards a long-term therapy with antibiotics has to be administered and surgical treatment for the esophageal damage should follow.
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Hanna, W., Lutterer, A., Reimer, P., Storck, M. (2011). Akute aortoösophageale Fistel – endovaskuläre Notfalltherapie. In: Rückert, R.I., Hepp, W., Luther, B. (eds) Chirurgie der abdominalen und thorakalen Aorta. Berliner Gefäßchirurgische Reihe, vol 11. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11719-0_29
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