RESUMEN
Arterio-ureteral fistulas (AUFs), which are relatively rare but potentially life-threatening, require prompt diagnosis and treatment. We reported a case of AUFs following robot-assisted laparoscopic radical cystectomy (RARC) with extended pelvic lymph node dissection and ileal conduit urinary diversion for muscle-invasive bladder cancer, which resulted in massive hemorrhage. Urine leaked from the anastomosis between the ureter, and the end of the ileal conduit was infected, which resulted in an AUF between the pseudoaneurysm of the right common iliac artery and the ureter. The AUF was managed successfully by vascular intervention with an arterial stent graft.
Asunto(s)
Aneurisma Falso , Cistectomía , Arteria Ilíaca , Laparoscopía , Procedimientos Quirúrgicos Robotizados , Enfermedades Ureterales , Fístula Urinaria , Fístula Vascular , Humanos , Cistectomía/efectos adversos , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Fístula Urinaria/etiología , Fístula Urinaria/cirugía , Enfermedades Ureterales/etiología , Enfermedades Ureterales/cirugía , Arteria Ilíaca/cirugía , Fístula Vascular/etiología , Fístula Vascular/cirugía , Masculino , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiología , Neoplasias de la Vejiga Urinaria/cirugía , Anciano , Persona de Mediana EdadRESUMEN
Pulmonary artery dissection is a rare and fatal disease. Diagnosis is mainly made during autopsy because most patients die suddenly due to pulmonary artery dissection in the pericardium resulting in pericardial tamponade. The optimum management is not clearly defined because of the paucity of cases in the literature. We describe the case of an 81-year-old man, affected by rheumatoid arthritis and with history of aortic valve replacement surgery, who attended an emergency department for non-specific symptoms, started complaining of chest pain rapidly deteriorated into cardiac shock. Computed tomography scan, performed on suspicion of an acute aortic pathology and/or a pulmonary embolism, allowed the identification of pulmonary artery dissection associated with aorto-pulmonary fistula. Despite early diagnosis in the emergency department, the outcome was unfortunately fatal.
Asunto(s)
Disección Aórtica , Arteria Pulmonar , Humanos , Anciano de 80 o más Años , Masculino , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico , Disección Aórtica/diagnóstico por imagen , Arteria Pulmonar/diagnóstico por imagen , Resultado Fatal , Tomografía Computarizada por Rayos X , Fístula Vascular/cirugía , Fístula Vascular/diagnóstico , Fístula Vascular/diagnóstico por imagenRESUMEN
A 56-year-old female presented to us with rheumatic mitral stenosis with a left atrial clot. We found one coronary cameral fistula on the coronary angiography from the posterior left ventricular branch to the left ventricle. She was taken up for surgical mitral valve replacement and clot removal. A residual coronary fistula may increase the risk of infective endocarditis, especially in the presence of mechanical prosthesis. Henceforth, intra-operatively, we used the methylene blue dye injection as an easy technique to detect and safely close the coronary fistula from inside the left ventricular chamber. She recovered smoothly with a successful outcome.
Asunto(s)
Angiografía Coronaria , Implantación de Prótesis de Válvulas Cardíacas , Azul de Metileno , Estenosis de la Válvula Mitral , Cardiopatía Reumática , Fístula Vascular , Humanos , Femenino , Persona de Mediana Edad , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/cirugía , Resultado del Tratamiento , Estenosis de la Válvula Mitral/diagnóstico por imagen , Estenosis de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/fisiopatología , Cardiopatía Reumática/diagnóstico por imagen , Cardiopatía Reumática/cirugía , Valor Predictivo de las Pruebas , Cuidados Intraoperatorios , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/cirugía , Trombectomía , Colorantes/administración & dosificaciónRESUMEN
BACKGROUND: An aortoesophageal fistula can prove to be fatal. Salvage thoracic endovascular aortic repair as a bridging therapy and radical surgery with thoracotomy should be considered while treating aortoesophageal fistula without spontaneous closure. Moreover, it is essential to select a technique that reduces the risk of reinfection. Here we report a rare case of a ruptured thoracic aortic aneurysm related to esophageal perforation by a fish bone that led to massive hematemesis and shock, and the surgical treatment of an aortoesophageal fistula that developed after salvage thoracic endovascular aortic repair. CASE PRESENTATION: A 70-year-old Japanese female patient was admitted with hematemesis, thoracic pain, and shock related to esophageal perforation of a ruptured descending aortic aneurysm caused by fish bone aspiration and esophageal perforation 1 month previously. An emergency thoracic endovascular aortic repair was performed. Postoperatively, an aortoesophageal fistula that remained open and a food intake-related increase in the inflammatory response was noted. Radical blood-vessel prosthesis implantation and fistula closure were performed. The patient's postoperative course was favorable and the patient was discharged 22 days after the blood vessel prosthesis implantation. CONCLUSION: Such a case of rupture of a descending aortic aneurysm related to perforation by a fish bone and an aortoesophageal fistula is considerably rare. Thus, we report the therapeutic strategy of this particular case and review the relevant literature.
Asunto(s)
Aneurisma de la Aorta Torácica , Rotura de la Aorta , Procedimientos Endovasculares , Fístula Esofágica , Perforación del Esófago , Humanos , Femenino , Fístula Esofágica/cirugía , Fístula Esofágica/etiología , Anciano , Procedimientos Endovasculares/métodos , Aneurisma de la Aorta Torácica/cirugía , Rotura de la Aorta/cirugía , Perforación del Esófago/cirugía , Perforación del Esófago/etiología , Fístula Vascular/cirugía , Fístula Vascular/etiología , Implantación de Prótesis Vascular , Terapia Recuperativa/métodos , Animales , Hematemesis/etiología , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/etiología , Aorta Torácica/cirugía , Resultado del Tratamiento , Peces , Reparación Endovascular de AneurismasRESUMEN
An aortoenteric fistula (AEF) is an uncommon cause of gastrointestinal bleeding that requires prompt diagnosis and intervention owing to its high mortality rate. Moreover, iliac aneurysmo-colonic fistula is an exceptionally infrequent presentation. We report a unique case of a 71-year-old male presenting with hematochezia, later diagnosed with a primary fistula between a common iliac artery aneurysm and the sigmoid colon. Initially, the patient was misdiagnosed as having a gastrointestinal stromal tumor, leading to delayed and emergent surgical intervention due to massive bleeding 2 days later. This case is particularly notable for its rarity, misinterpretation of the initial diagnosis, complicated surgical procedures, and development of complications including ischemic myopathy. This case highlights the criticality of accurate diagnosis with a high index of suspicion, significance of consultation with a vascular surgeon for vascular abnormalities, and importance of considering ischemic time in the sequence of surgical treatments to ensure timely and appropriate management.
Asunto(s)
Errores Diagnósticos , Hemorragia Gastrointestinal , Aneurisma Ilíaco , Fístula Intestinal , Fístula Vascular , Humanos , Masculino , Anciano , Fístula Intestinal/cirugía , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/etiología , Aneurisma Ilíaco/cirugía , Aneurisma Ilíaco/diagnóstico por imagen , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/cirugía , Fístula Vascular/etiología , Resultado del Tratamiento , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Valor Predictivo de las Pruebas , Tumores del Estroma Gastrointestinal/cirugía , Tumores del Estroma Gastrointestinal/diagnóstico por imagen , Tumores del Estroma Gastrointestinal/complicaciones , Tiempo de Tratamiento , Factores de Tiempo , Diagnóstico Tardío , Angiografía por Tomografía Computarizada , Colectomía , Enfermedades del Colon/cirugía , Enfermedades del Colon/etiología , Enfermedades del Colon/diagnóstico por imagen , Retraso del TratamientoRESUMEN
A 72-year-old male with a history of a triple-vessel coronary artery bypass graft years ago presented with a DeBakey type 2 aortic dissection and an aorto-left atrial fistula with patent bypass grafts (left internal mammary artery and saphenous vein grafts). He developed pulmonary oedema and required intubation. The right axillary artery was cannulated. After the ascending aorta and left internal mammary artery were clamped, the aorta was transected, leaving aortic tissue around two saphenous vein grafts as two separate patches. An entry tear was found adjacent to the proximal anastomosis of the saphenous vein graft to the posterior descending artery. A fistula, which was located between a false lumen in the non-coronary sinus and the dome of the left atrium, was primarily closed. Because the adventitia was thinned out in the non-coronary sinus due to aortic dissection, partial aortic root remodelling was performed with resuspension of the commissures. Hemiarch repair was performed under moderate hypothermia and unilateral antegrade cerebral perfusion. After systemic perfusion was resumed, the locations of the saphenous vein graft buttons were determined. The ascending graft was cross-clamped again; the saphenous vein graft to the obtuse marginal branch graft was reimplanted using the Carrel patch technique while a saphenous vein graft to the posterior descending artery required interposition of a 10-mm Dacron graft to accommodate the length.
Asunto(s)
Disección Aórtica , Puente de Arteria Coronaria , Atrios Cardíacos , Humanos , Masculino , Anciano , Atrios Cardíacos/cirugía , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/efectos adversos , Fístula Vascular/cirugía , Fístula Vascular/etiología , Fístula Vascular/diagnóstico , Fístula/cirugía , Fístula/etiología , Fístula/diagnóstico , Reoperación/métodos , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico , Vena Safena/trasplanteRESUMEN
BACKGROUND: Congenital left circumflex coronary artery fistula (LCX-CAF) is a relatively rare type of coronary artery fistula (CAF); little is known about the outcomes of transcatheter closure (TCC) of LCX-CAF. METHODS AND RESULTS: All consecutive patients admitted to Fuwai Hospital and scheduled for TCC of LCX-CAF between January 2012 and December 2022 were reviewed retrospectively. Of the 25 consecutive patients (mean [±SD] age 34±20 years; 48% male) admitted and scheduled for TCC of congenital LCX-CAF, the procedure was feasible in 22 (77.3%). The mean (±SD) diameter of the fistulas was 6.99±2.04 mm; 21 (84%) patients had a large fistula (i.e., diameter >2-fold greater than non-feeding coronary artery). Occluders were deployed via a transarterial approach and arteriovenous loop in 6 (27.3%) and 16 (72.7%) patients, respectively. No procedural complications were recorded. Although the procedural success rates are similar for single LCX-CAF and left anterior descending CAF (81.25% vs. 92.86%; P=0.602), the mean time from initial angiography to first occluder deployment is significantly longer for LCX-CAF (83.06±36.07 vs. 36.00±9.49 min; P<0.001). The mean (±SD) follow-up time was 62.2±45.5 months. The incidence of myocardial infarction and recanalization of the fistula was 4.5% (1/22) and 9.1% (2/22), respectively. CONCLUSIONS: TCC of LCX-CAF is a feasible and effective alternative to surgical repair, with comparable outcomes in selected patients. Optimal medical therapy to prevent post-closure myocardial infarction requires further investigation.
Asunto(s)
Cateterismo Cardíaco , Anomalías de los Vasos Coronarios , Humanos , Masculino , Femenino , Adulto , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/terapia , Anomalías de los Vasos Coronarios/cirugía , Estudios Retrospectivos , Persona de Mediana Edad , Cateterismo Cardíaco/métodos , Resultado del Tratamiento , Adulto Joven , Adolescente , Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/terapia , Fístula Vascular/cirugía , Fístula Vascular/congénitoAsunto(s)
Enfermedades de la Aorta , Fístula Intestinal , Fístula Vascular , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/diagnóstico por imagen , Fístula Vascular/diagnóstico , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/cirugía , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/diagnóstico , Masculino , AncianoRESUMEN
PURPOSE OF REVIEW: This review describes the presentation, diagnosis, and management of congenital coronary artery fistulas (CAFs) in adults. RECENT FINDINGS: CAFs are classified as coronary-cameral or coronary arteriovenous fistulas. Fistulous connections at the distal coronary bed are more likely to be aneurysmal with higher risk of thrombosis and myocardial infarction (MI). Medium-to-large or symptomatic CAFs can manifest as ischemia, heart failure, and arrhythmias. CAF closure is recommended when there are attributable symptoms or evidence of adverse coronary remodeling. Closure is usually achievable using transcatheter techniques, though large fistulas may require surgical ligation with bypass. Given their anatomic complexity, cardiac CT with multiplanar 3-D reconstruction can enhance procedural planning of CAF closure. Antiplatelet and anticoagulation are essential therapies in CAF management. CAFs are rare cardiac anomalies with variable presentations and complex anatomy. CAF management strategies include indefinite medical therapy, percutaneous or surgical CAF closure, and lifelong patient surveillance.
Asunto(s)
Anomalías de los Vasos Coronarios , Humanos , Anomalías de los Vasos Coronarios/terapia , Anomalías de los Vasos Coronarios/diagnóstico , Anomalías de los Vasos Coronarios/cirugía , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Adulto , Fístula Arteriovenosa/terapia , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/cirugía , Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Fístula Vascular/terapia , Fístula Vascular/cirugía , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/diagnóstico , Cateterismo Cardíaco/métodosRESUMEN
We describe what we believe to be the first reported case of a neonate with right coronary ostial atresia with the right coronary artery originating from the left circumflex coronary artery, in conjunction with a right coronary artery to right ventricle fistula in a patient with otherwise normal cardiac anatomy. This was found following an evaluation for a continuous murmur at 2 weeks of life with elevated troponin and abnormal electrocardiogram. Thus far the child has required no intervention and is asymptomatic at 17 months of age, but he will require long-term follow-up to monitor the size of the fistula and potential for myocardial insufficiency.
Asunto(s)
Anomalías de los Vasos Coronarios , Soplos Cardíacos , Humanos , Soplos Cardíacos/etiología , Recién Nacido , Masculino , Anomalías de los Vasos Coronarios/diagnóstico , Anomalías de los Vasos Coronarios/complicaciones , Ventrículos Cardíacos/anomalías , Electrocardiografía , Fístula Vascular/complicaciones , Fístula Vascular/diagnóstico , Fístula Vascular/cirugía , EcocardiografíaRESUMEN
BACKGROUND: Aortoesophageal fistula (AEF) is a rare condition characterized by communication between the aorta and esophagus. AEF caused by an esophageal foreign body is even rare, and there is currently no recommended standard treatment protocol. We report a case of delayed aortic rupture after the endoscopic removal of a fish bone, which was successfully treated with a combined approach of vascular stenting and thoracic surgery. CASE PRESENTATION: A 33-year-old man presented to the hospital after experiencing chest discomfort for 3 days following the accidental ingestion of a fish bone. Under endoscopic guidance, the fish bone was successfully removed, and the patient was subsequently admitted for medical therapy. On the fourth postoperative day, the patient suddenly developed hematemesis, and chest computed tomography angiography revealed the presence of an AEF. This necessitated urgent intervention; hence, thoracic surgery was performed and a vascular-covered stent was placed. Following the surgical procedure, the patient received active medical treatment, recovered well, and was successfully discharged from the hospital. CONCLUSIONS: In patients with esophageal perforation caused by foreign bodies, hospitalization for observation, computed tomography angiography examination, early use of antibiotics, and careful assessment of aortic damage are advised. Thoracic endovascular aortic repair and esophageal rupture repair may have benefits for the treatment of AEF.
Asunto(s)
Enfermedades de la Aorta , Fístula Esofágica , Fístula Vascular , Masculino , Animales , Humanos , Adulto , Cirugía Torácica Asistida por Video/efectos adversos , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/complicaciones , Fístula Esofágica/cirugía , Fístula Esofágica/complicaciones , Hemorragia Gastrointestinal , Stents/efectos adversos , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/etiología , Fístula Vascular/cirugíaRESUMEN
Aorto-esophageal fistula (AEF) due to esophageal cancer (EC) is a life-threatening condition characterized by sudden hemorrhage, which often causes sudden death. To evaluate the efficacy and safety of thoracic endovascular aortic repair (TEVAR) for AEF due to EC, we performed a systematic review and meta-analysis. We searched the MEDLINE (PubMed) databases, the Cochrane Library databases, Ichushi-Web (the databases of the Japan Medical Abstract Society), and CiNii (Academic information search service of the National Institute of Information from Japan) from January 2000 to November 2023 for articles about TEVAR for an emergent aortic hemorrhage (salvage TEVAR [S-TEVAR]), and the prophylactic procedure (P-TEVAR). Six studies (140 cases) were eligible for meta-analysis. The 90-day mortality of S-TEVAR and P-TEVAR was 40% (95% CI 23-60, I2 = 36%) and 8% (95% CI 3-17, I2 = 0%), respectively. Post-S-TEVAR hemorrhagic and infectious complications were 17% (95% CI 3-57, I2 = 71%) and 20% (95% CI 5-57, I2 = 66%), respectively. Post-P-TEVAR hemorrhagic and infectious complications were 2% (95% CI 0-10, I2 = 0%) and 3% (95% CI 1-12, I2 = 0%), respectively. TEVAR for AEF due to EC may be a useful therapeutic option to manage or prevent hemorrhagic oncological emergencies.
Asunto(s)
Aorta Torácica , Enfermedades de la Aorta , Reparación Endovascular de Aneurismas , Fístula Esofágica , Neoplasias Esofágicas , Fístula Vascular , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aorta Torácica/cirugía , Enfermedades de la Aorta/etiología , Enfermedades de la Aorta/cirugía , Reparación Endovascular de Aneurismas/efectos adversos , Reparación Endovascular de Aneurismas/métodos , Fístula Esofágica/etiología , Fístula Esofágica/cirugía , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/complicaciones , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Resultado del Tratamiento , Fístula Vascular/cirugía , Fístula Vascular/etiologíaRESUMEN
BACKGROUND: Aortoesophageal fistula (AEF) is an extremely rare and highly fatal complication leading to a high risk of morbidity and mortality. Successful management of AEF after esophagectomy for esophageal carcinoma has rarely been reported in the literature. CASE PRESENTATION: Here we present a rare case of a 44-year-old female with complications of AEF after esophagectomy for esophageal carcinoma, mainly presented as vomiting of blood. Both computed tomographic and computed tomography angiography of the chest showed bilateral pleural effusion and atelectasis, while gastroscopy showed large gastrointestinal bleeding. Emergency surgery was performed that included the removal of the mediastinal abscess, left lower pulmonary wedge resection, and thoracic endovascular aortic repair (TEVAR), followed by supportive treatment. The surgery went successful, and the patient was followed up for 1 year after discharge and showed good recovery. We also reviewed previous literature on the history, causes, pathophysiology, clinical presentation, diagnosis, and treatment of AEF after esophagectomy for esophageal adenocarcinoma. CONCLUSIONS: In our case, thoracotomy combined with TEVAR was effective in treating AEF after esophagectomy for esophageal adenocarcinoma. This case provides successful experiences for clinical diagnosis and treatment of AEF after esophagectomy for esophageal carcinoma.
Asunto(s)
Adenocarcinoma , Enfermedades de la Aorta , Carcinoma , Fístula Esofágica , Fístula Vascular , Adulto , Femenino , Humanos , Adenocarcinoma/cirugía , Adenocarcinoma/complicaciones , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/complicaciones , Carcinoma/cirugía , Reparación Endovascular de Aneurismas , Fístula Esofágica/etiología , Fístula Esofágica/cirugía , Esofagectomía/efectos adversos , Hemorragia Gastrointestinal , Fístula Vascular/etiología , Fístula Vascular/cirugíaRESUMEN
Aortic graft and endograft infections remain a significant source of morbidity and mortality after abdominal aortic aneurysm repair. With graft excision and extra-anatomic bypass, an infrarenal aortic stump remains which can have suture line dehiscence and catastrophic stump blowout. Treatment of this is extremely challenging, especially for severely co-morbid patients who cannot undergo major surgery, or in patients with a hostile abdomen. We present a case study of a 74-year-old male found to have an aortoenteric fistula (AEF). This case broadens operative options for this type of patient population by demonstrating an endovascular technique for addressing aortic stump blowout by parallel grafting and coil embolization of the visceral aorta.
Asunto(s)
Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular , Prótesis Vascular , Embolización Terapéutica , Procedimientos Endovasculares , Fístula Intestinal , Fístula Vascular , Humanos , Masculino , Anciano , Embolización Terapéutica/instrumentación , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/efectos adversos , Resultado del Tratamiento , Procedimientos Endovasculares/instrumentación , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/etiología , Fístula Vascular/cirugía , Fístula Vascular/terapia , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Fístula Intestinal/terapia , Aortografía , Angiografía por Tomografía Computarizada , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugíaRESUMEN
OBJECTIVE: Tracheoinnominate artery fistulas (TIFs) are a rare but deadly complication of tracheostomy. Tracheoinnominate artery fistula cases in the literature were summarized in order to understand mortality associations. METHODS: MEDLINE was searched for studies reporting individual characteristics of patients with TIFs after tracheostomy, excluding cases without tracheostomy or with additional procedures at the tracheostomy site. This study followed PRISMA guidelines. RESULTS: 121 TIF patients from 18 case series and 46 case reports were included. The median age was 40 years, and 52.9% were male. The overall mortality rate was 64.5%. There were differences in mortality between cases that presented initially with vs without sentinel bleeding (odds ratio [OR] .34; CI [confidence interval] .16-.73; P = .006). The mortality rate also differed in whether or not the tracheostomy cuff was over-inflated for temporary hemostasis during resuscitation (OR 3.57 (CI 1.57-8.09); P = .002). Treatment compared to no treatment had lower mortality rates (OR .11 (CI 0.04-.32); P < .001); no differences were found if treatment was endovascular vs open surgical. CONCLUSIONS: Mortality is a major concern after detection of a TIF and resuscitation paired with endovascular or open surgical intervention is imperative. Rapidly investigating sentinel bleeds and intervening upon hemorrhage with temporary cuff over inflation may lead to improved outcomes.
Asunto(s)
Traqueostomía , Fístula Vascular , Humanos , Masculino , Tronco Braquiocefálico/cirugía , Complicaciones Posoperatorias/mortalidad , Enfermedades de la Tráquea/etiología , Enfermedades de la Tráquea/mortalidad , Enfermedades de la Tráquea/cirugía , Traqueostomía/efectos adversos , Traqueostomía/métodos , Fístula Vascular/mortalidad , Fístula Vascular/etiología , Fístula Vascular/cirugíaRESUMEN
BACKGROUND: We report a one-stage surgery to the case of secondary aortoenteric fistula (sAEF) after prosthetic reconstruction of abdominal aortic aneurysm, by multifaceted approach. CASE PRESENTATION: A 63-year-old male was admitted to our unit under diagnosed of sAEF after prosthetic reconstruction of abdominal aortic aneurysm, and a pseudoaneurysm of thoracoabdominal aorta due to infection. The patient underwent emergency operation. Firstly, we placed the patient in a modified right lateral decubitus position and performed thoracoabdominal aortic replacement with retroperitoneal approach by thoracoretroperitoneal incision which combined thoracotomy and pararectal incision, and secondly, we changed to a supine position and performed closure of the duodenal fistula and omental flap transposition by midline abdominal incision. The patient was doing well without complications. CONCLUSIONS: A one-stage, multifaceted surgical approach covering both prosthetic reconstruction of thoracoabdominal aorta and closure of sAEF with omentopexy is reasonable and useful strategy.
Asunto(s)
Aneurisma de la Aorta Abdominal , Enfermedades de la Aorta , Implantación de Prótesis Vascular , Enfermedades Duodenales , Fístula Intestinal , Herida Quirúrgica , Fístula Vascular , Masculino , Humanos , Persona de Mediana Edad , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/etiología , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/complicaciones , Aorta/cirugía , Enfermedades Duodenales/complicaciones , Enfermedades Duodenales/cirugía , Implantación de Prótesis Vascular/efectos adversos , Fístula Vascular/cirugía , Fístula Vascular/complicaciones , Aorta Abdominal/cirugíaRESUMEN
OBJECTIVES: Secondary aortoenteric fistula is a rare and life-threatening condition. Clear evidence on the ideal therapeutic approach is largely missing. This study aims to analyze symptoms, etiology, risk factors, and outcomes based on procedural details. PATIENTS AND METHODS: All patients with secondary aortoenteric fistula admitted between 2003 and 2021 were included. Patient characteristics, surgical procedure details, and postoperative outcomes were analyzed. Outcomes were stratified and compared according to the urgency of operation and the procedure performed. Descriptive statistics were used. The primary endpoint was in-hospital mortality. RESULTS: A total of twentytwo patients (68% male, median age 70 years) were identified. Main symptoms were gastrointestinal bleeding, pain, and fever. From the twentytwo patients ten patients required emergency surgery and ten urgent surgery. Emergency patients were older on average (74 vs 63 years, P = .015) and had a higher risk of postoperative respiratory complications (80% vs 10%, P = .005). Primary open surgery with direct replacement of the aorta or an extra-anatomic bypass with an additional direct suture or resection of the involved bowel was performed in sixteen patients. In four patients underwent endovascular bridging treatment with the definitive approach as a second step. Other two patients died without operation (1x refusal; 1x palliative cancer history). In-hospital mortality was 27%, respectively. Compared to patients undergoing urgent surgery, those treated emergently showed significantly higher in-hospital (50% vs 0%, P = .0033) mortalities. CONCLUSION: Despite rapid diagnosis and treatment, secondary aortoenteric fistula remains a life-threatening condition with 27% in-hospital mortality, significantly increased upon emergency presentation.
Asunto(s)
Enfermedades de la Aorta , Fístula Intestinal , Fístula Vascular , Humanos , Masculino , Anciano , Femenino , Resultado del Tratamiento , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/etiología , Enfermedades de la Aorta/cirugía , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Complicaciones Posoperatorias , Aorta , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/etiología , Fístula Vascular/cirugíaAsunto(s)
Aneurisma Coronario , Enfermedad de la Arteria Coronaria , Fístula , Fístula Vascular , Humanos , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Aneurisma Coronario/complicaciones , Aneurisma Coronario/diagnóstico por imagen , Aneurisma Coronario/cirugía , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Fístula/diagnóstico por imagen , Fístula/cirugía , Angiografía Coronaria , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/cirugíaRESUMEN
BACKGROUND: Information regarding optimal revascularization and digestive tract repair in secondary aortoenteric fistula (sAEF) remains unclear. Thus, reporting treatment outcomes and presenting comprehensive patient details through a structured treatment approach are necessary to establish a treatment strategy for this rare, complex, and fatal condition. METHODS: We performed a single-center retrospective review of consecutive sAEF managed based on our in situ revascularization and intestinal repair strategy. The primary endpoint of this study was all-cause mortality, and secondary endpoints were the incidence of in-hospital complications and midterm reinfections. RESULTS: Between 2007 and 2020, 16 patients with sAEF, including 13 men (81%), underwent in situ revascularization and digestive tract repair. The median follow-up duration for all participants was 36 (interquartile range, 6-62) months. Among the participants, 81% (n = 13), 13% (n = 2), and 6% (n = 1) underwent aortic reconstruction with rifampin-soaked grafts, unsoaked Dacron grafts, and femoral veins, respectively. The duodenum was the most commonly involved site in enteric pathology (88%; n = 14), and 57% (n = 8) of duodenal breaks were repaired by a simple closure. Duodenum's second part-jejunum anastomosis was performed in 43% of patients (n = 6), and 19% of the patients (n = 3) died perioperatively. In-hospital complications occurred in 88% patients (n = 14), and the most frequent complication was gastrointestinal. Finally, 81% patients (n = 13) were discharged home. Oral antibiotics were administered for a median duration of 5.7 months postoperatively; subsequently, the participants were followed up carefully. Reinfection was detected in 6% of the patients (n = 1) who underwent reoperation without any complications. The 1-year and 3-year overall survival rates of participants were 75% (n = 12) and 75% (n = 9), respectively, and no sAEF-related deaths occurred, except perioperative death. CONCLUSIONS: Surgical intervention with contemporary management based on our vascular strategy and digestive tract procedure may be a durable treatment for sAEF.
Asunto(s)
Enfermedades de la Aorta , Implantación de Prótesis Vascular , Fístula Intestinal , Fístula Vascular , Masculino , Humanos , Resultado del Tratamiento , Prótesis Vascular/efectos adversos , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/complicaciones , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/métodos , Estudios Retrospectivos , Duodeno/cirugía , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/etiología , Fístula Vascular/cirugíaRESUMEN
BACKGROUND: Aortoesophageal fistula (AEF) is a rare but typically life-threatening condition. Although several treatment strategies exist, including conservative treatment with intraluminal stent graft and open thoracic aortic replacement, the overall outcome remains poor, ranging from 16 to 39%. Furthermore, esophageal reconstruction methods vary between hospitals. Herein, we report a case of aortoesophageal fistula treated using one-stage total reconstruction. CASE PRESENTATION: This case involved a 58-year-old woman who developed acute type A aortic dissection and underwent successful total arch replacement at the other hospital. However, she developed AEF 1 year later and underwent urgent thoracic endovascular aortic repair, which eventually failed. We performed thoracic aortic replacement, total esophagectomy, gastric tube reconstruction, and omental flap in a one-stage operation. The patient was extubated the next day and transferred to the general ward on postoperative day 3. Computed tomography revealed favorable results. CONCLUSIONS: For postoperative AEF, dedicated debridement with reconstruction is more effective than conservative treatment. In an experienced center, post-procedure-related AEF can be easily treated using one-stage reconstruction.