Prokakis Christos, Koletsis Efstratios, Apostolakis Efstratios, Dedeilias Panagiotis, Dougenis Dimitrios
Department of Cardiothoracic Surgery, Patras University School of Medicine, Patras, Greece.
Med Sci Monit. 2008 Apr;14(4):RA48-54.
Aortoesophageal fistula (AEF) is a rare cause of gastrointestinal bleeding with high mortality. Thoracic aorta aneurysms represent the leading cause of aortoesophageal fistula. Surgery offers the only chance for cure in these patients. So far there are no clear indications on the optimal management of these patients. A review of the literature was undertaken focusing on the surgical management of thoracic aorta aneurysm-related AEFs in an attempt to clarify the indications for the surgical or endovascular treatment of this entity. Only 37 successfully treated patients were identified. Most of them underwent open surgical repair with the intent to control both hemorrhage and mediastinal contamination. Thoracic aorta replacement with a synthetic graft was used in most cases. Cryopreserved homografts, extranatomic bypass, and endovascular stent grafting were used in a small number of patients. Esophageal manipulation using various techniques was undertaken in all patients with open surgical repair of their AEF. Based on the reported results and identified limitations of each approach, the present authors advocate open surgical repair of both aneurysm and esophageal defect as the treatment of choice in all patients with AEF and signs of infection in relatively good general condition. Stent grafting is considered a valid approach only for patients who cannot tolerate open repair. A combined technique of stent grafting for immediate bleeding control followed by open surgical repair of both aneurysm, preferably using homografts, and esophageal defect are extremely promising and may represent a more valid alternative to the classical open approach in the future.
主动脉食管瘘（AEF）是胃肠道出血的罕见原因，死亡率很高。胸主动脉瘤是主动脉食管瘘的主要原因。手术是这些患者唯一的治愈机会。到目前为止，对于这些患者的最佳治疗方案尚无明确的指征。本文对文献进行了综述，重点关注胸主动脉瘤相关AEF的手术治疗，以试图阐明该疾病手术或血管内治疗的指征。仅确定了37例成功治疗的患者。他们中的大多数人接受了开放手术修复，目的是控制出血和纵隔污染。大多数情况下采用人工血管置换胸主动脉。少数患者使用了冷冻保存的同种异体移植物、解剖外旁路和血管内支架植入术。所有接受AEF开放手术修复的患者都采用了各种技术进行食管操作。基于所报道的结果以及每种方法所确定的局限性，本文作者主张，对于所有患有AEF且全身状况相对良好并有感染迹象的患者，首选开放手术修复动脉瘤和食管缺损。支架植入术仅被认为是不能耐受开放修复患者的有效方法。一种先采用支架植入术立即控制出血，随后对动脉瘤（最好使用同种异体移植物）和食管缺损进行开放手术修复的联合技术极具前景，可能在未来代表一种比传统开放方法更有效的替代方案。
