Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China.
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Acta Radiol. 2021 Apr;62(4):447-452. doi: 10.1177/0284185120933228. Epub 2020 Jun 17.
Aortoesophageal fistula (AEF) is a rare but fatal condition causing massive upper gastrointestinal bleeding.
To report our experiences in the management of life-threatening AEF.
A total of eight patients (seven men, one woman; mean age = 59.4 years; age range = 43‒76 years) presenting with AEF between 2005 and 2018 were recruited from three different Korean hospitals. The medical records of these patients were reviewed for patient demographics, clinical features, diagnostic and therapeutic modalities, and outcomes.
Two patients died as a result of massive hemorrhage before endovascular or surgical treatment could be undertaken. Of the six patients who were treated, five underwent endovascular interventions: embolization of the fistula using n-butyl cyanoacrylate (NBCA) and subsequent thoracic endovascular aortic repair (TEVAR) in two patients; TEVAR alone in two patients; and NBCA embolization alone in one patient. Among them, three patients who received TEVAR with or without NBCA embolization in a timely fashion recovered and were discharged. One patient who received delayed TEVAR died of disseminated intravascular coagulation, and one who received NBCA embolization alone died of hemorrhagic shock, both dying within three days of treatment. The remaining patient who underwent surgical aortic repair is alive after 13 years.
Rapid identification and surgical treatment are necessary to increase the likelihood of survival, if emergency surgery is feasible. TEVAR in a timely fashion facilitates hemodynamic stabilization by rapidly controlling hemorrhage and saves the patient's life.
主动脉食管瘘（AEF）是一种罕见但致命的疾病，可导致大量上消化道出血。
报告我们在处理危及生命的 AEF 方面的经验。
从三家不同的韩国医院招募了 2005 年至 2018 年间出现 AEF 的 8 名患者（7 名男性，1 名女性；平均年龄 59.4 岁；年龄范围 43-76 岁）。回顾这些患者的病历，以了解患者人口统计学、临床特征、诊断和治疗方式以及结果。
有 2 名患者在接受血管内或手术治疗之前因大出血而死亡。在接受治疗的 6 名患者中，5 名接受了血管内介入治疗：2 名患者使用 n-丁基氰基丙烯酸酯（NBCA）栓塞瘘管，随后进行胸主动脉腔内修复术（TEVAR）；2 名患者仅进行 TEVAR；1 名患者仅进行 NBCA 栓塞。其中，3 名患者及时接受了 TEVAR 加或不加 NBCA 栓塞治疗后康复并出院。1 名患者因弥漫性血管内凝血接受延迟 TEVAR 后死亡，1 名患者因出血性休克接受单纯 NBCA 栓塞后死亡，均在治疗后三天内死亡。另一名接受主动脉手术修复的患者在 13 年后仍然存活。
如果可行，快速识别和外科治疗对于提高生存机会至关重要。及时进行 TEVAR 可通过迅速控制出血来稳定血流动力学，从而挽救患者生命。
