A Case of Survival after Thoracic Endovascular Aortic Repair for Descending Thoracic Aortic Aneurysm Rupture and Aortoesophageal Fistula without Esophagectomy
- VernacularTitle:胸部下行大動脈瘤破裂・大動脈食道瘻に対して胸部大動脈ステントグラフト内挿術のみで中期生存を得た1例
- Author:
Norihisa TOMINAGA
1
;
Daisuke MACHIDA
1
;
Norio YUKAWA
1
;
Munetaka MASUDA
2
;
Shinichi SUZUKI
1
Author Information
- Keywords: descending thoracic aortic aneurysm (DTA); aortoesophageal fistula (AEF); thoracic endovascular aortic repair (TEVAR)
- From:Japanese Journal of Cardiovascular Surgery 2024;53(3):136-142
- CountryJapan
- Language:Japanese
- Abstract: The patient was an 82-year-old woman. For dysphagia scrutiny, upper gastrointestinal endoscopy and biopsy of a submucosal tumor of the midthoracic esophagus were performed. The patient was urgently admitted to the Department of Gastroenterology for examination and treatment. After admission, enhanced CT showed a descending thoracic aortic aneurysm (DTA) pressing on the esophagus. On the third day of hospitalization, the patient suffered massive hematemesis and went into shock, and emergency thoracic endovascular aortic repair (TEVAR) was performed with resuscitation based on the diagnosis of esophageal perforation of the DTA. The patient was weaned from the ventilator by tracheotomy without cerebrospinal complications and left the intensive care unit on the seventh postoperative day. One month after surgery, a CT scan showed that the DTA had almost disappeared and that the esophageal compression had been released. The patient was managed with antibacterial therapy and nutritional support other than oral intake and was discharged home 7 months after surgery without stent graft infection or mediastinitis. The usefulness of TEVAR for ruptured descending thoracic aortic aneurysms has been reported in many cases. However, in patients with an aortoesophageal fistula (AEF), esophagectomy is required after TEVAR to control infection, and the mortality rate of this disease is high. We report a case in which infection were controlled by antibacterial therapy and nutritional management other than oral intake after TEVAR and the patient survived.
