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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2008 June;15(2):137-41
Aorto-esophageal fistula due to aortic endovascular prosthesis. Case report and management
Gentilli S., Pizzorno C., Pessione S., Garavoglia M.
Department of Surgery University Amedeo Avogadro Piemonte Orientale Novara, Italy
Aorto-esophageal fistula is a rare and often fatal condition due to pathologies of the aorta and of the esophagus; recently a new etiology for aorto-esophageal fistulas has been detected: the decubitus of aortic endovascular prosthesis previously positioned for a traumatic aneurysm of the descending aorta. Symptoms have been first described by Chiari (Chiari’s triad): 1) chest pain and/or dysphagea; 2) hematemesis; 3) massive hematemesis. If the patient is hemodynamically stable the gold standard diagnostic exam is the computed tomography scan with contrast media. Aorto-esophageal fistulas present with an acute clinical setting rapidly worsening and the postoperative morbidity and mortality result high. The aortoesophageal fistula treatment is divided in three progressive steps: 1) bleeding control; 2) mediastinitis prevention; 3) esophageal repair. This article reports the case of a 59-year-old male patient with an aorto-esophageal fistula due to the decubitus of an endovascular aortic prosthesis previously positioned for a traumatic aneurysm of the descending aorta. The bleeding was controlled in emergency with a Sengstaken-Blakemore tube. As cardio-vascular surgeons excluded any intervention a bipolar esophageal exclusion to transit was performed in the Department of General Surgery, and subsequently an expandable esophageal prosthesis was positioned in reversal way. The patient has survived for seven months. The cause of death was a septic shock.