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Therapeutic strategy for treating aortoesophageal fistulas

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Abstract

Purpose

The development fistulas between the thoracic aorta and the esophagus are highly fatal conditions. We aimed to identify a therapeutic strategy for treating aortoesophageal fistula (AEF) in this study, by investigating all AEF cases presented in this special symposium at the 65th Annual Scientific Meeting of the Japanese Association for Thoracic Surgery.

Methods

Forty-seven AEF patients were included in this study. The survivors and nonsurvivors at six and 18 months after diagnosis of AEF were classified into “Group A6”, “Group D6”, “Group A18”, and “Group D18”, respectively. Comparisons between Group A6 and Group D6 and between Group A18 and Group D18 were made with regard to therapeutic strategy.

Results

Twenty-two (46.8 %) and 33 (70.3 %) of the 47 patients died within 6 and 18 months, respectively. The patients treated with omentum wrapping (p = 0.0052), esophagectomy (p = 0.0269) and a graft replacement strategy for the aorta (p = 0.002) were more frequently included in Group A6. The patients with the omentum wrapping (p = 0.0174) and esophagectomy (p = 0.0203) and graft replacement were more significantly included in Group A18. The results of the multivariate analysis indicated that the mortality rate at 6 and 18 months after diagnosis was significantly correlated with graft replacement (p = 0.0188) and esophagectomy (p = 0.0257), respectively. There were significant differences in the actuarial survival curves in patients who had omentum wrapping, graft replacement, and esophagectomy compared to patients who did not have these 3 therapeutic procedures.

Conclusion

The use of thoracic endovascular aortic repair alone for AEF should not be considered a definitive surgery. In contrast, esophagectomy, open surgery with aortic replacement using prostheses and homografts and greater omentum wrapping significantly improve the mid-term survival of AEF.

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Conflict of interest

The authors have declared that no conflict of interest exists.

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Authors and Affiliations

  1. Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830, Japan

    Hidetoshi Akashi, Satoru Tobinaga, Hiroyuki Tanaka & Hiromasa Fujita

  2. Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan

    Shunsuke Kawamoto & Yoshikatsu Saiki

  3. Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

    Tomohiko Sakamoto & Yoshiki Sawa

  4. Division of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital and Hyogo Emergency Medical Center, Kobe, Japan

    Takuro Tsukube

  5. Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Suguru Kubota & Yoshiro Matsui

  6. Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan

    Norihisa Karube & Kiyotaka Imoto

  7. Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Katsuhiro Yamanaka & Yutaka Okita

  8. Iwaki Kyoritu Hospital, Iwaki, Japan

    Shunichi Kondo

Authors
  1. Hidetoshi Akashi
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  2. Shunsuke Kawamoto
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  11. Katsuhiro Yamanaka
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  13. Satoru Tobinaga
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  14. Hiroyuki Tanaka
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  15. Yutaka Okita
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  16. Hiromasa Fujita
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Corresponding author

Correspondence to Hidetoshi Akashi.

Additional information

This review was submitted at the invitation of the editorial committee.

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Akashi, H., Kawamoto, S., Saiki, Y. et al. Therapeutic strategy for treating aortoesophageal fistulas. Gen Thorac Cardiovasc Surg 62, 573–580 (2014). https://doi.org/10.1007/s11748-014-0452-4

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  • DOI: https://doi.org/10.1007/s11748-014-0452-4

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