Peress Shira, Tuqan Wa'el, Thomas Austin
The University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA.
Department of Gastroenterology, Ochsner Clinic Foundation, New Orleans, LA.
Ochsner J. 2021 Winter;21(4):406-412. doi: 10.31486/toj.20.0142.
The most common aortic arch abnormality is an aberrant right subclavian artery (ARSA). ARSA-esophageal fistula is a rare sequela that can present with a life-threatening upper gastrointestinal (GI) bleed. We report the case of an 88-year-old male who presented with signs of upper GI bleeding. Esophagogastroduodenoscopy demonstrated extrinsic compression of the upper third of the esophagus with ulceration. Imaging studies revealed ARSA posterior to the esophagus with pseudoaneurysm formation. These findings confirmed an upper GI bleed secondary to ARSA-esophageal fistula. The patient underwent prompt embolization of the ARSA pseudoaneurysm, followed a few days later by coil embolization of the ARSA pseudoaneurysm. Despite these interventions, the patient continued to have bleeding with anemia. He and his family opted to avoid any further interventions and instead pursued comfort care. The patient was discharged to hospice and died 3 months later. ARSA-esophageal fistula is a rare but potentially lethal cause of upper GI bleeding. Initial signs and symptoms can be subtle, but the presence of a GI bleed requires immediate stabilization. Surgical interventions have been shown to have longer-lasting success, but endovascular repair may be an option for patients who are deemed unfit for surgery but still require prompt stabilization. Regardless of the intervention, mortality rates for ARSA-esophageal fistula are high.
最常见的主动脉弓异常是右锁骨下动脉异常（ARSA）。ARSA - 食管瘘是一种罕见的后遗症，可表现为危及生命的上消化道（GI）出血。我们报告一例88岁男性患者，其出现上消化道出血症状。食管胃十二指肠镜检查显示食管上三分之一处有外部压迫并伴有溃疡形成。影像学研究显示食管后方有ARSA并伴有假性动脉瘤形成。这些发现证实了由ARSA - 食管瘘引起的上消化道出血。患者迅速接受了ARSA假性动脉瘤的栓塞治疗，几天后又进行了ARSA假性动脉瘤的弹簧圈栓塞治疗。尽管采取了这些干预措施，患者仍持续出血并伴有贫血。他和他的家人选择避免进一步的干预措施，而是采取舒适护理。患者出院后进入临终关怀机构，3个月后去世。ARSA - 食管瘘是上消化道出血的一种罕见但潜在致命的原因。最初的体征和症状可能不明显，但出现消化道出血需要立即稳定病情。手术干预已被证明具有更持久的成功效果，但血管内修复可能是那些被认为不适合手术但仍需要迅速稳定病情的患者的一种选择。无论采取何种干预措施，ARSA - 食管瘘的死亡率都很高。
