Division of Vascular and Interventional Radiology, Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
Division of Vascular Surgery, Department of Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
Diagn Interv Radiol. 2021 Jan;27(1):122-125. doi: 10.5152/dir.2020.20033.
Immediate intervention is needed for aortoesophageal fistulas (AEF), a rare but highly lethal cause of massive gastrointestinal hemorrhage. Emergent thoracic endovascular aortic repair (TEVAR) is considered first-line treatment for massive bleeding from AEFs. We describe an unusual and challenging case of TEVAR coverage of an AEF involving the central aortic arch immediately followed by in vivo endograft fenestration to regain arch vessel perfusion. In vivo fenestration, currently a procedure for emergency or investigational purposes only, was shown to be life saving in our case. The main complications associated with the procedure included stroke and infection, requiring esophagectomy and cervical diversion as well as ongoing antibiotic treatment.
需要立即干预主动脉食管瘘（AEF），这是一种罕见但极具致命性的胃肠道大出血原因。急诊胸主动脉腔内修复术（TEVAR）被认为是治疗 AEF 大出血的一线治疗方法。我们描述了一个不常见且具有挑战性的病例，即 TEVAR 覆盖涉及主动脉弓中心的 AEF，随后立即进行体内移植物开窗以恢复弓血管灌注。目前仅用于紧急或研究目的的体内开窗术在我们的病例中被证明是救生的。该手术相关的主要并发症包括中风和感染，需要进行食管切除术和颈部转流术以及持续的抗生素治疗。
