Charité - Universitätsmedizin Berlin, Clinic of Vascular Surgery, Campus Benjamin Franklin, Berlin, Germany.
Charité - Universitätsmedizin Berlin, Clinic of Vascular Surgery, Campus Benjamin Franklin, Berlin, Germany.
Ann Vasc Surg. 2021 Apr;72:419-429. doi: 10.1016/j.avsg.2020.10.009. Epub 2020 Nov 21.
This study aims to review and compare the clinical presentation, management, and outcome in patients with tumor-related (TR) and nontumor-related (NTR) aorto-esophageal fistula (AEF) and aorto-bronchial fistula (ABF) with particular focus on the thoracic endovascular aortic repair.
We retrospectively reviewed a series of 16 consecutive patients with TR (n = 8) and NTR (n = 8), ABF (n = 6), and AEF (n = 10) admitted to our hospital from 2011 to 2019.
The median age was 62 years (range 46-81), with 11 men. The most common predisposing factor was esophageal or gastric cardia cancer (n = 6), followed by open repair of the thoracic aorta (n = 5). Endoluminal vacuum therapy (Endo-SPONGE®) accounted for 3 cases of AEFs. Thoracic endovascular aortic repair (TEVAR) was applied in 13 patients (4 with ABFs and 9 with AEFs). The primary technical success of the TEVARs was 100%. One patient (8%) was complicated with postoperative middle cerebral artery syndrome and left-sided hemiparesis. The respective in-hospital, 6-month, and 1-year mortality rates were 0% (n = 0), 25% (n = 2), and 25% (n = 2) for the NTR group and 63% (n = 5), 88% (n = 7), and 100% (n = 8) for the TR group. After a mean period of 13 months, 5 (31%) patients were still alive, and one patient lost to follow-up after 11 months. The survivors (n = 5) had all nontumor-related ABF. Progression of underlying cancer and hemodynamic shock were the most common causes of death.
TEVAR represents a reliable option in the treatment of NTR ABFs. In the cases of TR fistulas and NTR AEFs, TEVAR should be applied more selectively. The associated mortality remains very high.
本研究旨在回顾和比较肿瘤相关性（TR）和非肿瘤相关性（NTR）主动脉-食管瘘（AEF）和主动脉-支气管瘘（ABF）患者的临床表现、治疗和结局，特别关注胸主动脉腔内修复术（TEVAR）。
我们回顾性分析了 2011 年至 2019 年期间我院收治的 16 例连续患者，其中 TR（n=8）和 NTR（n=8）、ABF（n=6）和 AEF（n=10）。
中位年龄为 62 岁（范围 46-81），男性 11 例。最常见的诱发因素是食管或胃贲门癌（n=6），其次是胸主动脉开放修复（n=5）。腔内真空治疗（Endo-SPONGE®）占 3 例 AEF。13 例患者接受了胸主动脉腔内修复术（TEVAR），其中 4 例 ABF 和 9 例 AEF。TEVAR 的主要技术成功率为 100%。1 例（8%）患者术后并发大脑中动脉综合征和左侧偏瘫。NTR 组分别为 0%（n=0）、25%（n=2）和 25%（n=2），TR 组为 63%（n=5）、88%（n=7）和 100%（n=8）。平均 13 个月后，5 例（31%）患者仍存活，1 例（8%）患者失访 11 个月后。5 例存活患者（n=5）均为非肿瘤相关性 ABF。基础癌症进展和血流动力学休克是死亡的最常见原因。
TEVAR 是治疗 NTR ABF 的可靠选择。在 TR 瘘和 NTR AEF 的情况下，TEVAR 的应用应更加具有选择性。相关死亡率仍然很高。
