Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection.
10.5090/kjtcs.2016.49.1.54
- Author:
Jae Hong LEE
1
;
Bubse NA
;
Yoohwa HWANG
;
Yong Han KIM
;
In Kyu PARK
;
Kyung Hwan KIM
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Korea. kkh726@snu.ac.kr
- Publication Type:Case Report
- Keywords:
Fistula;
Aorta;
Surgery;
Esophagus
- MeSH:
Abscess;
Aorta;
Aorta, Thoracic;
Brachiocephalic Trunk;
Carotid Artery, Common;
Chills;
Drainage;
Elephants;
Esophagus;
Fever;
Fistula*;
Follow-Up Studies;
Humans;
Male;
Middle Aged;
Subclavian Artery;
Transplants*
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2016;49(1):54-58
- CountryRepublic of Korea
- Language:English
-
Abstract:
A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient's postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up.
