Gombert Alexander, Grommes Jochen, Kotelis Drosos, Jacobs Michael J
European Vascular Center Aachen-Maastricht, Universitätsklinikum RWTH Aachen, Deutschland.
Zentralbl Chir. 2018 Oct;143(5):475-479. doi: 10.1055/a-0713-0457. Epub 2018 Oct 24.
Aortoesophageal fistula (AEF) following open or endovascular operations of the thoracoabdominal aorta is a rare, yet life-threatening condition. In this case, the whole thoracic aorta has to be replaced using a "clamshell approach" because of an AEF following open repair of the ascending aorta after type A dissection and a thoracic endovascular aortic repair (TEVAR).
In 2015 a 43-year old woman suffered a type A dissection and underwent open supracoronary ascending aortic replacement including the proximal aortic arch. In 2016, she developed severe haemoptysis. An AEF could be detected and TEVAR was performed as emergency treatment. The further steps of the repair included oesophagectomy and repair of the whole thoracic aorta using a transverse thoracotomy - a clamshell approach.
The curative treatment of AEF, which is based on radical, open repair of the oesophagus and the involved aortic segments, is challenging. A clamshell approach is a feasible option when replacement of the whole thoracic aorta is required.
胸腹主动脉开放手术或血管腔内手术后发生的主动脉食管瘘（AEF）是一种罕见但危及生命的疾病。在此病例中，由于A型主动脉夹层升主动脉开放修复术后及胸主动脉腔内修复术（TEVAR）后发生AEF，必须采用“蛤壳式入路”替换整个胸主动脉。
2015年，一名43岁女性发生A型主动脉夹层，接受了包括近端主动脉弓在内的冠状动脉上开放升主动脉置换术。2016年，她出现严重咯血。检测到AEF并进行了TEVAR作为紧急治疗。修复的进一步步骤包括食管切除术和采用横断胸廓切开术——蛤壳式入路修复整个胸主动脉。
基于对食管和受累主动脉节段进行根治性开放修复的AEF治疗具有挑战性。当需要替换整个胸主动脉时，蛤壳式入路是一种可行的选择。
