Management of Tumor- and Nontumor-related Aorto-esophageal and Aorto-bronchial Fistulas
| Autor: | Katharina Beyer, Matthias Buerger, Safwan Omran, Lavinia Ardalani, Alexander Gombert, Andreas Greiner, Jan Paul Frese, Maximilian de Bucourt |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Fistula Clinical Decision-Making Aortic Diseases Hemodynamics 030204 cardiovascular system & hematology Risk Assessment 030218 nuclear medicine & medical imaging Blood Vessel Prosthesis Implantation Esophageal Fistula 03 medical and health sciences 0302 clinical medicine Risk Factors medicine.artery medicine Humans Thoracic aorta Aged Retrospective Studies Aged 80 and over Vascular Fistula Middle cerebral artery syndrome business.industry Mortality rate Endovascular Procedures Cancer General Medicine Middle Aged Thoracic Neoplasms Esophageal cancer medicine.disease Surgery Treatment Outcome Hemiparesis Female Bronchial Fistula medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Annals of Vascular Surgery. 72:419-429 |
| ISSN: | 0890-5096 |
| Popis: | Background This study aims to review and compare the clinical presentation, management, and outcome in patients with tumor-related (TR) and nontumor-related (NTR) aorto-esophageal fistula (AEF) and aorto-bronchial fistula (ABF) with particular focus on the thoracic endovascular aortic repair. Methods We retrospectively reviewed a series of 16 consecutive patients with TR (n = 8) and NTR (n = 8), ABF (n = 6), and AEF (n = 10) admitted to our hospital from 2011 to 2019. Results The median age was 62 years (range 46–81), with 11 men. The most common predisposing factor was esophageal or gastric cardia cancer (n = 6), followed by open repair of the thoracic aorta (n = 5). Endoluminal vacuum therapy (Endo-SPONGE®) accounted for 3 cases of AEFs. Thoracic endovascular aortic repair (TEVAR) was applied in 13 patients (4 with ABFs and 9 with AEFs). The primary technical success of the TEVARs was 100%. One patient (8%) was complicated with postoperative middle cerebral artery syndrome and left-sided hemiparesis. The respective in-hospital, 6-month, and 1-year mortality rates were 0% (n = 0), 25% (n = 2), and 25% (n = 2) for the NTR group and 63% (n = 5), 88% (n = 7), and 100% (n = 8) for the TR group. After a mean period of 13 months, 5 (31%) patients were still alive, and one patient lost to follow-up after 11 months. The survivors (n = 5) had all nontumor-related ABF. Progression of underlying cancer and hemodynamic shock were the most common causes of death. Conclusions TEVAR represents a reliable option in the treatment of NTR ABFs. In the cases of TR fistulas and NTR AEFs, TEVAR should be applied more selectively. The associated mortality remains very high. |
| Databáze: | OpenAIRE |
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