Clements Austin, Touros Kiara, Bearden Greg, Horst Vernon
Department of Vascular Surgery, Baptish Health, Birmingham, AL.
J Vasc Surg Cases Innov Tech. 2025 Aug 5;11(6):101940. doi: 10.1016/j.jvscit.2025.101940. eCollection 2025 Dec.
Subclavian artery-esophageal fistula is a rare but potentially fatal vascular anomaly. Inherent to Downs syndrome, trisomy 21 presents with a variety of rare cardiac and vascular anomalies. Subclavian-esophageal fistulae are rare and often fatal complications of a right-sided aortic arch. We herein describe a rare case of a 31-year-old man with trisomy 21 who developed massive upper gastrointestinal hemorrhage secondary to an aberrant left subclavian artery-esophageal fistula requiring vascular surgical intervention. Although the etiology remains uncertain, we suspect that our patient's subclavian-artery esophageal fistula developed as a result of a combination of nasogastric tube compression and endotracheal/tracheostomy compression in the setting of aberrant left subclavian artery and a right-sided aortic arch. A broad differential and high index of suspicion is required in diagnosing a patient with trisomy 21 with known congenital cardiac and aortic arch anomaly presenting with acute upper gastrointestinal hemorrhage.
锁骨下动脉-食管瘘是一种罕见但可能致命的血管异常。21三体综合征（唐氏综合征）患者常伴有各种罕见的心脏和血管异常。锁骨下-食管瘘是右侧主动脉弓罕见且常致命的并发症。我们在此描述一例罕见病例，一名31岁的21三体综合征男性患者，因异常的左锁骨下动脉-食管瘘导致大量上消化道出血，需要进行血管外科干预。尽管病因尚不确定，但我们怀疑患者的锁骨下动脉-食管瘘是在异常左锁骨下动脉和右侧主动脉弓的情况下，由鼻胃管压迫和气管插管/气管切开压迫共同作用所致。对于患有21三体综合征且已知有先天性心脏和主动脉弓异常并出现急性上消化道出血的患者，诊断时需要进行广泛的鉴别诊断并保持高度怀疑。
