Fístula aortoesofágica: una urgencia endovascular

IF 0.3 Q4 SURGERY
Eloy Rueda-Gomariz , Inmaculada Ballesteros Yáñez , Aníbal Bermúdez-García , Tomás Daroca-Martínez
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Abstract

Introduction

The aortoesophageal fistula is a rare entity with a poor prognosis. The typical clinical presentation is as described by Chiari: dysphagia/chest pain, sentinel bleeding, and massive hemorrhage. Upper gastrointestinal endoscopy and computed tomography scan are fundamental for diagnosis. As for treatment, it is not clearly established. The aim of this article is to present our experience with a case of aortoesophageal fístula treated through transaxillary Thoracic Endovascular Aortic Repair (TEVAR).

Methods

A 63-year-old male patient with a history of diabetes mellitus, smoker, chronic renal failure, and peripheral vascular disease presented with an episode of hematemesis with associated syncope and melaena. The patient underwent upper gastrointestinal endoscopy and computed tomography with intravenous contrast. After diagnosis, the patient underwent implantation of a Medtronic Valiant Navion stent graft via left transaxillary approach after placement of a Sengstaken-Blakemore catheter.

Results

Endoscopy suggested an aortoesophageal fistula, and computed tomography revealed 2 aneurysms in the descending aorta, one of which was in contact with the esophagus. The patient underwent implantation of a stent graft via transaxillary approach after placement of a Sengstaken-Blakemore tube, with good clinical outcome.

Conclusions

The aortoesophageal fistula is a rare and potentially lethal entity that requires a high diagnostic suspicion and emergency treatment, which is not established. Stent graft implantation is a safe therapeutic option as a bridge to patient stabilization, but definitive treatment must be individualized according to case characteristics and etiology.
主动脉食管瘘:血管内急症
摘要主动脉食管瘘是一种少见的疾病,预后较差。典型的临床表现如Chiari所描述的:吞咽困难/胸痛,前哨出血和大出血。上消化道内窥镜检查和计算机断层扫描是诊断的基础。至于治疗,目前还没有明确的规定。本文的目的是介绍我们通过经腋窝胸主动脉血管内修复术(TEVAR)治疗食管主动脉fístula的经验。方法男性,63岁,有糖尿病、吸烟、慢性肾衰竭、周围血管疾病病史,以呕血伴晕厥、黑绀发作为临床表现。患者接受了上消化道内窥镜检查和计算机断层扫描及静脉造影剂。确诊后,患者在置入Sengstaken-Blakemore导管后,经左腋下入路植入美敦力Valiant Navion支架。结果内镜提示主动脉食管瘘,ct示降主动脉2个动脉瘤,其中1个与食管接触。患者在置入Sengstaken-Blakemore管后经腋窝入路行支架植入术,临床效果良好。结论主动脉食管瘘是一种罕见且具有潜在致命性的疾病,需要高度的诊断怀疑和急诊治疗,目前尚不明确。支架植入术是一种安全的治疗选择,作为病人稳定的桥梁,但最终的治疗必须根据病例特征和病因进行个体化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
0.50
自引率
66.70%
发文量
109
审稿时长
69 days
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