Thorac cardiovasc Surg
DOI: 10.1055/s-0039-1692659
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

First Result of a Tailored Progressive Multistep Approach for the Treatment of Aorto-esophageal Fistulae

Marius Julian Helmedag
1  Department of General-, Visceral- and Transplantation Surgery, Universitatsklinikum Aachen, Aachen, Germany
,
Roman Eickhoff
1  Department of General-, Visceral- and Transplantation Surgery, Universitatsklinikum Aachen, Aachen, Germany
,
Andreas Lambertz
1  Department of General-, Visceral- and Transplantation Surgery, Universitatsklinikum Aachen, Aachen, Germany
,
Daniel Heise
1  Department of General-, Visceral- and Transplantation Surgery, Universitatsklinikum Aachen, Aachen, Germany
,
Jochen Grommes
2  Department of Vascular Surgery, European Vascular Center, Universitatsklinikum Aachen, Aachen, Germany
,
Michael Jacobs
2  Department of Vascular Surgery, European Vascular Center, Universitatsklinikum Aachen, Aachen, Germany
,
Ulf Peter Neumann
1  Department of General-, Visceral- and Transplantation Surgery, Universitatsklinikum Aachen, Aachen, Germany
,
Christian Klink
1  Department of General-, Visceral- and Transplantation Surgery, Universitatsklinikum Aachen, Aachen, Germany
› Author Affiliations
Further Information

Publication History

24 January 2019

06 May 2019

Publication Date:
15 July 2019 (online)

Abstract

Background Aorto-esophageal fistulae (AEFs) are a rare but serious and life-threatening disease of the mediastinum. Especially, AEF in the presence of infected stent grafts, for example, after thoracic endovascular aortic repair (TEVAR) is only curable by a multistage interdisciplinary surgical approach. This study presents the results of our four-stage approach consisting of bridging TEVAR, esophagectomy, complete stent removal followed by total bovine tube aortic replacement (TBTAR), and finally esophageal reconstruction.

Methods A case series of four patients from our department receiving a four-stage treatment of AEF is presented in this study. Retrospective database analysis focusing on overall survival, duration of intensive care unit and total hospital stay until discharge, complications, surgical time frame, and completion of chosen surgical treatment course was performed.

Results Overall, four patients surgically treated for AEF since May 2015 were included. A 30-day mortality was 0%, and overall survival at 1 year was 75%. All patients survived more than 5 months and could be discharged after TEVAR and esophagectomy. TBTAR could be performed in two of four patients (50%). Esophageal reconstruction was completed in all patients. Average follow-up was 20.3 ± 1.7 months or until death.

Conclusion The acute management of AEF using this approach seems satisfactory, especially for reducing acute short-term mortality. Complete restoration of the circulatory system and digestive tract remains challenging and is associated with high morbidity. We support the application of bridging TEVAR with a staggered approach to further surgical treatment individually tailored to the patient.