Hageman J H, Nein A G, Davis J T
Department of Surgery, Medical College of Ohio, Toledo 43699, USA.
Cardiovasc Surg. 1995 Oct;3(5):495-9. doi: 10.1016/0967-2109(95)94448-6.
A 55-year-old woman suffered an episode of massive hematemesis caused by an aortoesophageal fistula from an atherosclerotic thoracoabdominal aortic aneurysm. In situ grafting of the thoracic portion of the aneurysm was followed by sepsis and a sinus tract between the mid-esophagus and the aortic prosthesis. Graft removal, aortic closure, esophageal closure and axillobifemoral bypass allowed clearing of the sepsis and recovery. Severe hypertension followed aortic closure and extra-anatomic bypass and resulted in the eventual death of the patient 16 months later from dissection of the ascending aorta with pericardial tamponade. There are very few treated cases of aortoesophageal fistulas caused by atherosclerotic aneurysms reported in the literature. Furthermore, there are no reported cases where the aorta was closed at the level of the subclavian artery with extra-anatomic bypass to restore blood flow to the lower half of the body.
一名55岁女性因动脉粥样硬化性胸腹主动脉瘤导致的主动脉食管瘘发生大量呕血。对动脉瘤的胸段进行原位移植后出现脓毒症，且在食管中段与主动脉假体之间形成了窦道。移除移植物、闭合主动脉、闭合食管并进行腋股动脉旁路移植术，使脓毒症得以清除，患者康复。主动脉闭合和解剖外旁路移植术后出现严重高血压，最终患者在16个月后因升主动脉夹层伴心包填塞死亡。文献报道中由动脉粥样硬化性动脉瘤引起的主动脉食管瘘的治疗病例极少。此外，尚无在锁骨下动脉水平闭合主动脉并采用解剖外旁路移植术恢复身体下半部血流的病例报道。
