RESUMEN
A 62-year-old man was admitted to the hospital due to sepsis secondary to a hemodialysis catheter-related infection that, upon diagnostic evaluation, demonstrated to be caused by P. aeruginosa and was treated with meropenem. Eradication of the infectious episode was confirmed by blood workup, including cultures. One month after the initial episode, the patient was readmitted due to a symptomatic penetrating aortic ulcer, which was classified as a cardiovascular emergency. The patient underwent an aortic stent-graft placement. Four weeks later, he presented to the emergency department with a 2-hour onset of thoracic pain and massive hematemesis. The esophagus and aortic segment with aortic stent graft were resected en bloc after an aortoesophageal fistula was diagnosed.
Asunto(s)
Aneurisma de la Aorta Torácica , Enfermedades de la Aorta , Implantación de Prótesis Vascular , Fístula Esofágica , Fístula Vascular , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/etiología , Enfermedades de la Aorta/cirugía , Implantación de Prótesis Vascular/efectos adversos , Fístula Esofágica/diagnóstico por imagen , Fístula Esofágica/etiología , Fístula Esofágica/cirugía , Humanos , Masculino , Persona de Mediana Edad , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/etiología , Fístula Vascular/cirugíaRESUMEN
The carotid-esophageal fistula is a rare and serious complication of the metallic esophageal prosthesis. A high index of suspicion is required for early diagnosis and treatment, decreasing the morbidity and mortality rate of this severe complication. We report a case of a 4-year-old boy presenting severe upper gastrointestinal bleeding due to a carotid-esophageal fistula, secondary to deployment of an esophageal metallic prosthesis for treatment of a recurrent stenosis. The carotid pseudo-aneurism was successfully treated with stents and coils. Although endovascular treatment is a safe and effective option, arterial stenting in children needs further studies with long-term follow-up.
Asunto(s)
Arterias Carótidas , Embolización Terapéutica , Procedimientos Endovasculares , Fístula Esofágica/terapia , Estenosis Esofágica/terapia , Implantación de Prótesis/instrumentación , Stents , Fístula Vascular/terapia , Arterias Carótidas/diagnóstico por imagen , Preescolar , Embolización Terapéutica/instrumentación , Procedimientos Endovasculares/instrumentación , Fístula Esofágica/diagnóstico por imagen , Fístula Esofágica/etiología , Estenosis Esofágica/diagnóstico por imagen , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Implantación de Prótesis/efectos adversos , Recurrencia , Resultado del Tratamiento , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/etiologíaRESUMEN
The formation of a fistula between large caliber arteries and the digestive tract is an uncommon complication of reconstructive surgery of the large vessels secondary to the use of vascular prostheses, which manifest themselves with massive hemorrhages with high mortality. We report two cases of aorto-enteric fistula and carotid-esophageal fistula that share common characteristics such as the clinical manifestation of massive and fatal gastrointestinal bleeding in patients with a history of vascular prosthesis placement.
Asunto(s)
Enfermedades de la Aorta/etiología , Enfermedades de las Arterias Carótidas/etiología , Fístula Esofágica/etiología , Fístula Vascular/etiología , Anciano , Prótesis Vascular/efectos adversos , Hemorragia Gastrointestinal , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Índice de Severidad de la EnfermedadRESUMEN
RESUMEN La formación de una fístula entre arterias de gran calibre y el tubo digestivo es una complicación infrecuente de la cirugía reconstructiva de los grandes vasos sanguíneos secundario al uso de prótesis vasculares, los cuales se manifiestan con hemorragias masivas con elevada mortalidad. Presentamos dos casos de fístula aorto-entérico y de fístula carotideo-esofágico que comparten características comunes como la manifestación clínica de hemorragia digestiva masiva y mortal en pacientes con antecedentes de colocación de prótesis vasculares.
ABSTRACT The formation of a fistula between large caliber arteries and the digestive tract is an uncommon complication of reconstructive surgery of the large vessels secondary to the use of vascular prostheses, which manifest themselves with massive hemorrhages with high mortality. We report two cases of aorto-enteric fistula and carotid-esophageal fistula that share common characteristics such as the clinical manifestation of massive and fatal gastrointestinal bleeding in patients with a history of vascular prosthesis placement.
Asunto(s)
Anciano , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Aorta/etiología , Enfermedades de las Arterias Carótidas/etiología , Fístula Vascular/etiología , Fístula Esofágica/etiología , Complicaciones Posoperatorias/etiología , Índice de Severidad de la Enfermedad , Prótesis Vascular/efectos adversos , Hemorragia GastrointestinalAsunto(s)
Humanos , Masculino , Anciano , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma Falso/diagnóstico por imagen , Aorta , Aneurisma de la Aorta/complicaciones , Tomografía Computarizada por Rayos X , Fístula Vascular/etiología , Aneurisma Falso/complicaciones , Ecocardiografía Transesofágica , Fístula/etiología , Atrios Cardíacos , Cardiomiopatías/etiologíaAsunto(s)
Aneurisma Falso/diagnóstico por imagen , Aneurisma de la Aorta/diagnóstico por imagen , Anciano , Aneurisma Falso/complicaciones , Aorta , Aneurisma de la Aorta/complicaciones , Cardiomiopatías/etiología , Ecocardiografía Transesofágica , Fístula/etiología , Atrios Cardíacos , Humanos , Masculino , Tomografía Computarizada por Rayos X , Fístula Vascular/etiologíaRESUMEN
A fístula aorto-atrial direita é uma comunicação anômala, que representa uma grave e infrequente complicação da endocardite infecciosa. Neste estudo, relata-se o caso de um paciente de 53 anos, do sexo masculino, com histórico evolutivo patológico de endocardite infecciosa e acometimento de valva aórtica. Sob imagem de ecocardiograma, demonstrou-se abscesso perivalvar aórtico, estendendo-se à parede atrial direita, com necessidade de abordagem cirúrgica. Foram realizados a anuloplastia valvar aórtica e implante de valva mecânica. Após 1 mês de evolução pós-cirúrgica, realizou-se novo ecocardiograma, que acusou shunt de débito da raiz da aorta para o átrio direito. A conduta diante do caso foi discutida entre equipe clínica e cirúrgica, visando a possíveis falhas na terapêutica inicial. (AU)
Right aorto-atrial fistula is an anomalous communication that represents a serious and infrequent complication of infective endocarditis. This study reports the case of a 53-year-old male patient, with a pathological evolutionary history of infective endocarditis and aortic valve involvement. The echocardiogram shows an aortic perivalvar abscess extending to the right atrial wall, requiring a surgical approach. Aortic valve annuloplasty and mechanical valve implantation were performed. After a month of post-surgical evolution, a new echocardiogram was performed, which showed aortic root to right atrium shunt. The behavior in this case was discussed between the clinical and surgical teams, aiming at possible failures in the initial therapy. (AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Fístula Vascular/etiología , Endocarditis Bacteriana/complicaciones , Ecocardiografía , Fístula Vascular/diagnóstico por imagen , Endocarditis Bacteriana/cirugía , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Anuloplastia de la Válvula Cardíaca/efectos adversos , Antibacterianos/uso terapéuticoAsunto(s)
Procedimientos Endovasculares/métodos , Fístula Esofágica/cirugía , Neoplasias Esofágicas/complicaciones , Fístula Vascular/cirugía , Angiografía/métodos , Enfermedades de la Aorta/etiología , Enfermedades de la Aorta/patología , Oclusión con Balón/instrumentación , Fístula Esofágica/etiología , Fístula Esofágica/patología , Esófago/patología , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Fístula Vascular/etiología , Fístula Vascular/patologíaRESUMEN
When an aortoenteric fistula (AEF) arises secondary to suprarenal or more proximal aortic repair, mortality and the complexity of the surgery increases. We present the first reported case to our knowledge of a secondary AEF arising 13 years after surgical repair of middle aortic syndrome. We performed the original surgery on a 22-year-old male who presented with hypertension and claudication by placing a Dacron prosthetic patch on the juxtarenal and infrarenal aorta, bilateral vein bypasses to the left and right renal artery, and a Dacron bypass to the proximal superior mesenteric artery. Thirteen years later, he presented with massive gastrointestinal bleeding and syncope. We performed a distal descending thoracic aortic rifampin-soaked bifurcated Dacron graft to the left renal artery and to a large meandering mesenteric artery followed by excision of all previous prosthetic graft and insertion of a rifampin-soaked tube graft from the distal descending thoracic aorta to the distal abdominal aorta with omental flap coverage. After a complicated postoperative course, he was discharged 2 months later and remains on dialysis at his 6-month postoperative follow-up without evidence of recurrent infection.
Asunto(s)
Enfermedades de la Aorta/cirugía , Implantación de Prótesis Vascular/efectos adversos , Remoción de Dispositivos , Enfermedades Duodenales/cirugía , Fístula Intestinal/cirugía , Fístula Vascular/cirugía , Adulto , Enfermedades de la Aorta/diagnóstico , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Enfermedades Duodenales/diagnóstico , Enfermedades Duodenales/etiología , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/etiología , Masculino , Diseño de Prótesis , Reoperación , Colgajos Quirúrgicos , Factores de Tiempo , Resultado del Tratamiento , Fístula Vascular/diagnóstico , Fístula Vascular/etiologíaRESUMEN
A 68-year-old woman with ventilator-dependent respiratory failure and multiple comorbidities developed acute massive hemoptysis. Computed tomographic angiogram revealed a 3.9-cm pseudoaneurysm arising from the innominate artery abutting the trachea. The patient was successfully treated with stent graft insertion via the right common carotid artery, with exclusion of the aneurysm from the proximal innominate to the right common carotid artery, with ligation of the proximal right subclavian artery and right common carotid to subclavian artery bypass. The patient remained medically stable for 3 months after the procedure with no evidence of endoleak or infection. She then developed recurrent hemoptysis with fatal cardiac arrest. Open surgical repair has been the treatment of choice for tracheoinnominate artery fistula. However, direct repair confers a high mortality risk. Endovascular exclusion offers a less invasive treatment option for tracheoinnominate artery fistula and can serve as a bridge for patients with potential for becoming better surgical candidates.
Asunto(s)
Aneurisma Falso/cirugía , Implantación de Prótesis Vascular , Tronco Braquiocefálico/cirugía , Procedimientos Endovasculares , Fístula del Sistema Respiratorio/cirugía , Enfermedades de la Tráquea/cirugía , Traqueostomía/efectos adversos , Fístula Vascular/cirugía , Anciano , Aneurisma Falso/diagnóstico , Aneurisma Falso/etiología , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Tronco Braquiocefálico/diagnóstico por imagen , Arteria Carótida Común/cirugía , Procedimientos Endovasculares/instrumentación , Resultado Fatal , Femenino , Paro Cardíaco , Hemoptisis/etiología , Humanos , Ligadura , Diseño de Prótesis , Radiografía , Recurrencia , Fístula del Sistema Respiratorio/diagnóstico , Fístula del Sistema Respiratorio/etiología , Stents , Arteria Subclavia/cirugía , Enfermedades de la Tráquea/diagnóstico , Enfermedades de la Tráquea/etiología , Resultado del Tratamiento , Fístula Vascular/diagnóstico , Fístula Vascular/etiologíaRESUMEN
We report a case of an acquired aorta-right atrial fistula, secondary to a ruptured proximal anastomosis of an old saphenous vein graft 12 years after a coronary artery bypass surgery, in a 57 year old patient with multiple cardiovascular risk factors. On admission, he presented with congestive heart failure and on examination a continuous murmur was detected on the right parasternal border. Catheterization showed a fistula from the proximal anastomosis of an occluded right coronary artery saphenous vein graft draining to the right atrium with a large left to right shunt. The fistula was successfully occluded by a percutaneous approach with a Life Tech duct occluder with complete resolution of heart failure. The patient was discharged one week afterwards. After a two-year follow-up, the fistula remained occluded.
Asunto(s)
Estenosis Coronaria/cirugía , Vasos Coronarios/cirugía , Oclusión de Injerto Vascular/complicaciones , Cardiopatías/etiología , Vena Safena/trasplante , Fístula Vascular/etiología , Angiografía Coronaria , Fístula/diagnóstico , Fístula/etiología , Oclusión de Injerto Vascular/diagnóstico , Atrios Cardíacos , Cardiopatías/diagnóstico , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Rotura Espontánea , Tomografía Computarizada por Rayos X , Fístula Vascular/diagnósticoRESUMEN
Esophageal squamous cell carcinoma can spread locally to neighboring organs in the mediastinum. When it invades the aorta, the patient may develop an aorto esophageal fistula (AEF), complication that carries a high mortality rate. We report a 62-year-old male with stage IV esophageal carcinoma who, after chemo radiation treatment, developed an AEF. He was successfully treated with the use of an aortic endograft. The patient died 13 months later due to progression of his cancer, without evidence of sepsis or new bleeding episodes.
Asunto(s)
Enfermedades de la Aorta/etiología , Carcinoma de Células Escamosas/complicaciones , Fístula Esofágica/etiología , Neoplasias Esofágicas/complicaciones , Fístula Vascular/etiología , Enfermedades de la Aorta/cirugía , Procedimientos Endovasculares , Fístula Esofágica/cirugía , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Fístula Vascular/cirugíaRESUMEN
Background: Esophageal squamous cell carcinoma can spread locally to neighboring organs in the mediastinum. When it invades the aorta, the patient may develop an aorto esophageal fistula (AEF), complication that carries a high mortality rate. We report a 62-year-old male with stage IV esophageal carcinoma who, after chemo radiation treatment, developed an AEF. He was successfully treated with the use of an aortic endograft. The patient died 13 months later due to progression of his cancer, without evidence of sepsis or new bleeding episodes.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Aorta/etiología , Carcinoma de Células Escamosas/complicaciones , Fístula Esofágica/etiología , Neoplasias Esofágicas/complicaciones , Fístula Vascular/etiología , Enfermedades de la Aorta/cirugía , Procedimientos Endovasculares , Fístula Esofágica/cirugía , Resultado Fatal , Fístula Vascular/cirugíaRESUMEN
Aorto-cavitary fistulae are rare complications of infective endocarditis. The diagnosis, in the absence of concomitant aortic valve disease, replacement of aortic valve with homograft or prosthetic valve, periannular abscess and negative blood culture, requires a high index of suspicion and has important prognostic and management significance. The sensitivity of the Modified Duke Criteria is challenged in this case report with a documented right sinus of valsalva fistula to the right ventricle seen on transthoracic echocardiography.
Los fístulas aorto-cavitarias son complicaciones raras de la endocarditis infecciosa. El diagnóstico - en ausencia de la enfermedad concomitante de la válvula aórtica, el reemplazo de válvula aórtica con homoinjertos o válvulas protésicas, absceso perianular, y cultivo de sangre negativo - requiere un alto índice de sospecha, y reviste gran importancia para la prognosis y el tratamiento. En este reporte de caso, se cuestiona la sensibilidad de los Criterios de Duke Modificados, con la documentación de una fístula del seno de valsalva derecho hacia el ventrículo derecho, observada en una ecocardiografía transtorácica.
Asunto(s)
Adolescente , Femenino , Humanos , Enfermedades de la Aorta/etiología , Endocarditis/complicaciones , Fístula/etiología , Cardiopatías/etiología , Tetralogía de Fallot/complicaciones , Enfermedades de la Aorta , Ecocardiografía Doppler en Color , Endocarditis , Fístula , Cardiopatías , Ventrículos Cardíacos , Tetralogía de Fallot , Fístula Vascular/etiología , Fístula VascularRESUMEN
Aorto-cavitary fistulae are rare complications of infective endocarditis. The diagnosis, in the absence of concomitant aortic valve disease, replacement of aortic valve with homograft or prosthetic valve, periannular abscess and negative blood culture, requires a high index of suspicion and has important prognostic and management significance. The sensitivity of the Modified Duke Criteria is challenged in this case report with a documented right sinus of valsalva fistula to the right ventricle seen on transthoracic echocardiography.
Asunto(s)
Enfermedades de la Aorta/etiología , Endocarditis/complicaciones , Fístula/etiología , Cardiopatías/etiología , Tetralogía de Fallot/complicaciones , Adolescente , Enfermedades de la Aorta/diagnóstico por imagen , Ecocardiografía Doppler en Color , Endocarditis/diagnóstico por imagen , Femenino , Fístula/diagnóstico por imagen , Cardiopatías/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Tetralogía de Fallot/diagnóstico por imagen , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/etiologíaRESUMEN
We report a 16-year-old boy, who suffered a right vent ride penetrating injury caused by a sharp blade that evolved to cardiac tampon. He underwent surgery and was discharged four days later. Thirteen days later, a cardiac murmur was found. An echocardiography showed an aorta-right ventricular fistula. Surgical closure was performed through an aortotomy on cardiopulmonary by pass. The control echocardiography showed a small residual fistula, which closed spontaneously three months later.
Asunto(s)
Lesiones Cardíacas/cirugía , Fístula Vascular/cirugía , Heridas por Arma de Fuego/complicaciones , Adolescente , Aorta/lesiones , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/cirugía , Ecocardiografía Transesofágica , Ventrículos Cardíacos/lesiones , Humanos , Masculino , Remisión Espontánea , Fístula Vascular/etiologíaRESUMEN
We report a 16-year-old boy, who suffered a right vent ride penetrating injury caused by a sharp blade that evolved to cardiac tampon. He underwent surgery and was discharged four days later. Thirteen days later, a cardiac murmur was found. An echocardiography showed an aorta-right ventricular fistula. Surgical closure was performed through an aortotomy on cardiopulmonary by pass. The control echocardiography showed a small residual fistula, which closed spontaneously three months later.
Asunto(s)
Adolescente , Humanos , Masculino , Lesiones Cardíacas/cirugía , Fístula Vascular/cirugía , Heridas por Arma de Fuego/complicaciones , Aorta/lesiones , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/cirugía , Ecocardiografía Transesofágica , Ventrículos Cardíacos/lesiones , Remisión Espontánea , Fístula Vascular/etiologíaRESUMEN
BACKGROUND AND OBJECTIVES: In patients with hemoptysis and a history of aortic surgery, the possibility of aortobronchopulmonary fistula must always be considered. The objective of this study was to report a rare case of hemoptysis due to aortobronchopulmonary fistula in the late postoperative period of aortic surgery. CASE REPORT: Female patient, 34 years, surgical correction of aortic coarctation, presenting massive hemoptysis. The echocardiogram disclosed a pseudoaneurysm. The surgical correction was performed and a Dacron tube graft was implanted in the affected aortic segment successfully. CONCLUSIONS: Aortobronchopulmonary fistulas must be considered in patients with previous aortic surgery, due to the elevated morbimortality if they are not promptly diagnosed and treated.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Coartación Aórtica/cirugía , Fístula Bronquial/etiología , Complicaciones Posoperatorias/etiología , Fístula Vascular/etiología , Adulto , Femenino , Hemoptisis/etiología , HumanosRESUMEN
JUSTIFICATIVA E OBJETIVOS: Em pacientes com hemoptise e história de cirurgia aórtica, a possibilidade de fístula aortobroncopulmonar deve sempre ser considerada. O objetivo deste estudo foi relatar um caso raro de hemoptise por fístula aortobroncopulmonar em pós-operatório tardio de cirurgia aórtica. RELATO DE CASO: Mulher, 34 anos, correção cirúrgica de coarctação de aorta na infância, apresentando hemoptise maciça. Ecocardiograma evidenciou pseudoaneurisma. Foi realizada a cirurgia e implantado tubo de dacron no segmento aórtico envolvido com sucesso. CONCLUSÕES: Fístula aortobroncopulmonar deve ser lembrada em pacientes com cirurgia aórtica prévia, principalmente pela elevada morbimortalidade se não diagnosticada e tratada precocemente.
BACKGROUND AND OBJECTIVES: In patients with hemoptysis and a history of aortic surgery, the possibility of aortobronchopulmonary fistula must always be considered. The objective of this study was to report a rare case of hemoptysis due to aortobronchopulmonary fistula in the late postoperative period of aortic surgery. CASE REPORT: Female patient, 34 years, surgical correction of aortic coarctation, presenting massive hemoptysis. The echocardiogram disclosed a pseudoaneurysm. The surgical correction was performed and a Dacron tube graft was implanted in the affected aortic segment successfully. CONCLUSIONS: Aortobronchopulmonary fistulas must be considered in patients with previous aortic surgery, due to the elevated morbimortality if they are not promptly diagnosed and treated.
JUSTIFICATIVA: En pacientes con hemoptisis e historia de cirugía aórtica, la posibilidad de fístula aortobroncopulmonar siempre debe tenerse en cuenta. OBJETIVOS: Relatar un caso raro de hemoptisis por fístula aortobroncopulmonar en postoperatorio tardío de cirugía aórtica. INFORME DE CASO: Mujer, 34 años, corrección quirúrgica de coartación de la aorta en la infancia, presentando hemoptisis masiva. Ecocardiograma mostró evidencias de seudoaneurisma. Se realizó la cirugía, implantándose con éxito un tubo de dacron en el segmento aórtico involucrado. CONCLUSIONES: La fístula aortobroncopulmonar debe ser considerada en pacientes con cirugía aórtica previa, principalmente por la elevada morbimortalidad cuando no es diagnosticada y tratada precozmente.