Sladojevic Milos, Bjelovic Milos, Ilic Nikola, Mutavdzic Perica, Koncar Igor, Dragas Marko, Markovic Miroslav, Davidovic Lazar
Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery - First Surgical Hospital, Clinical Center of Serbia, Belgrade, Serbia.
Ann Vasc Surg. 2017 Oct;44:417.e11-417.e16. doi: 10.1016/j.avsg.2017.01.019. Epub 2017 May 11.
Aortoesophageal (AEF) and aortobronchial fistula (ABF) after thoracic endovascular aortic repair (TEVAR) are rare complications with catastrophic consequences without treatment. In this case report, we presented a patient with AEF and ABF after TEVAR successfully treated with endograft explantation and replaced by Dacron graft followed by esophagectomy and left principal bronchus repairing. We report a patient with AEF and ABF after TEVAR who was evaluated due to dysphagia and chest pain followed by hematemesis and hemoptysis. Endoscopic examination revealed lesion of the esophageal wall with chronic abscess formation and stent-graft protrusion into the cavity. Patient was operated on with extracorporeal circulation. AEF and ABF were confirmed intraoperatively. Endograft was explanted and in situ reconstruction of thoracic aorta was carried out with tubular Dacron 22-mm prosthesis wrapped with omental flap. After aortic reconstruction, esophageal mucosal stripping was performed with cervical esophagostomy, pyloromyotomy, and Stamm-Kader gastrostomy for nutrition. In addition, omentoplasty of the defect in the left principal bronchus was performed. To re-establish peroral food intake esophagocoloplasty was carried out 8 months after previous surgery utilizing transversosplenic segment of the colon and retrosternal route. In very selective cases, stent-graft explantation and in situ reconstruction with Dacron graft covered by omental flap followed by esophagectomy and bronchus repairing permit adequate debridement reducing the risk of mediastinitis and graft infection and allow a safe esophageal reconstruction in a second procedure.
胸主动脉腔内修复术（TEVAR）后发生的主动脉食管瘘（AEF）和主动脉支气管瘘（ABF）是罕见的并发症，若不治疗会导致灾难性后果。在本病例报告中，我们介绍了一名TEVAR术后发生AEF和ABF的患者，成功接受了移植物取出术，并用涤纶补片进行了替换，随后进行了食管切除术和左主支气管修复。我们报告了一名TEVAR术后发生AEF和ABF的患者，该患者因吞咽困难和胸痛就诊，随后出现呕血和咯血。内镜检查发现食管壁病变，伴有慢性脓肿形成，支架移植物突入腔内。患者在体外循环下接受手术。术中证实为AEF和ABF。取出移植物，用带网膜瓣包裹的22毫米管状涤纶假体对胸主动脉进行原位重建。主动脉重建后，进行食管黏膜剥脱术，并做颈段食管造口术、幽门切开术和 Stamm-Kader胃造口术以维持营养。此外，对左主支气管的缺损进行了网膜成形术。为重新建立经口进食，在先前手术8个月后，利用结肠的横脾段和胸骨后途径进行了食管结肠吻合术。在非常特殊的情况下，取出支架移植物并用带网膜瓣覆盖的涤纶补片进行原位重建，随后进行食管切除术和支气管修复，可进行充分的清创，降低纵隔炎和移植物感染的风险，并允许在第二步手术中安全地进行食管重建。
