Ahmad Nouman, Huang Lingjin, Chen Xuliang, Xie Zhongshang, Wu Shaobing, Chen Zhengji
Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Ann Thorac Surg Short Rep. 2024 Jan 11;2(3):528-534. doi: 10.1016/j.atssr.2023.12.009. eCollection 2024 Sep.
The aortoesophageal fistula (AEF) caused by thoracic endovascular aortic repair is a challenging condition. Traditional treatment approaches have been associated with high mortality and morbidity. This study introduces a modified single-stage surgical strategy that aims to optimize outcomes and to reduce the risk of recurrence for AEF.
Our method involving mediastinal infection clearance, direct esophageal repair, aortic remnant cavity isolation with omental refilling, and aortic reconstruction with a Dacron graft (alongside the native aorta) was applied to all the patients.
None of the patients experienced intraoperative or in-hospital mortality. All 3 patients recovered well and exhibited successful repair and functionality at discharge. Our approach effectively controlled infection, repaired aortic and esophageal defects, and prevented future complications. Our experiences indicate a positive impact of this management strategy.
Our single-stage surgical approach offers a promising solution for AEF after thoracic endovascular aortic repair, enhancing patients' quality of life. It achieves excellent outcomes in infection control and aortic and esophageal repair while avoiding the need for multiple staged surgical procedures.
胸段血管腔内主动脉修复术所致的主动脉食管瘘（AEF）是一种具有挑战性的病症。传统治疗方法的死亡率和发病率一直很高。本研究引入了一种改良的单阶段手术策略，旨在优化治疗效果并降低AEF复发风险。
我们的方法包括纵隔感染清除、食管直接修复、用网膜填充隔离主动脉残余腔以及用涤纶补片（沿天然主动脉）进行主动脉重建，所有患者均采用该方法。
所有患者均未发生术中或院内死亡。所有3例患者恢复良好，出院时修复成功且功能正常。我们的方法有效控制了感染，修复了主动脉和食管缺损，并预防了未来的并发症。我们的经验表明了这种管理策略的积极影响。
我们的单阶段手术方法为胸段血管腔内主动脉修复术后的AEF提供了一种有前景的解决方案，提高了患者的生活质量。它在感染控制以及主动脉和食管修复方面取得了优异的效果，同时避免了多次分期手术的需要。
