Skip to main content
Journal cover image

Aortoesophageal fistula after thoracic aortic stent-graft placement: a rare but catastrophic complication of a novel emerging technique.

Publication ,  Journal Article
Eggebrecht, H; Mehta, RH; Dechene, A; Tsagakis, K; Kühl, H; Huptas, S; Gerken, G; Jakob, HG; Erbel, R
Published in: JACC Cardiovasc Interv
June 2009

OBJECTIVES: Our goal was to report characteristics and outcomes of 6 patients with aortoesophageal fistula (AEF) after thoracic endovascular aortic repair (TEVAR). BACKGROUND: Neurologic events are severe complications of TEVAR. With growing experience of TEVAR, other yet unexpected devastating complications have emerged. METHODS: Between July 1999 and August 2008, 268 patients underwent TEVAR for various thoracic aortic diseases at our institution. RESULTS: Six of 268 patients (age 49 to 77 years, 50% female patients) developed AEF (incidence 1.9%) within 1 to 16 months after the procedure. Indications for TEVAR were acute aortic dissection (n = 3), chronic aortic dissection (n = 1), and thoracic aortic aneurysm (n = 2). Four patients presented with sudden massive hematemesis whereas 2 patients were readmitted for new-onset fever and elevated markers of inflammation that preceded hematemesis. Esophago-gastro-duodenoscopy identified deep esophageal ulcerations at the level of the implanted aortic stent-graft in 4 patients, but only mild erosive lesions within the proximal esophagus without signs of active bleeding in the remaining 2 patients. Surgical repair was performed in only 1 patient and declined in the remaining because of comorbidities and multiorgan system failure. Despite this, all patients died due to fatal rebleeding (n = 4) or mediastinitis (n = 2). CONCLUSIONS: AEF is a rare and unusual complication of TEVAR that occurs relatively early after the procedure and is almost invariably fatal. New-onset fever with elevated inflammatory markers or hematemesis should heighten clinical suspicion of AEF in TEVAR patients and prompt computed tomography or esophago-gastro-duodenoscopy in the hope of detecting, triaging, and treating this early to improve the otherwise dismal outcomes of these patients.

Duke Scholars

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

June 2009

Volume

2

Issue

6

Start / End Page

570 / 576

Location

United States

Related Subject Headings

  • Vascular Fistula
  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Stents
  • Middle Aged
  • Mediastinitis
  • Male
  • Inflammation Mediators
  • Humans
  • Hemorrhage
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Eggebrecht, H., Mehta, R. H., Dechene, A., Tsagakis, K., Kühl, H., Huptas, S., … Erbel, R. (2009). Aortoesophageal fistula after thoracic aortic stent-graft placement: a rare but catastrophic complication of a novel emerging technique. JACC Cardiovasc Interv, 2(6), 570–576. https://doi.org/10.1016/j.jcin.2009.03.010
Eggebrecht, Holger, Rajendra H. Mehta, Alexander Dechene, Konstantinos Tsagakis, Hilmar Kühl, Sebastian Huptas, Guido Gerken, Heinz G. Jakob, and Raimund Erbel. “Aortoesophageal fistula after thoracic aortic stent-graft placement: a rare but catastrophic complication of a novel emerging technique.JACC Cardiovasc Interv 2, no. 6 (June 2009): 570–76. https://doi.org/10.1016/j.jcin.2009.03.010.
Eggebrecht H, Mehta RH, Dechene A, Tsagakis K, Kühl H, Huptas S, et al. Aortoesophageal fistula after thoracic aortic stent-graft placement: a rare but catastrophic complication of a novel emerging technique. JACC Cardiovasc Interv. 2009 Jun;2(6):570–6.
Eggebrecht, Holger, et al. “Aortoesophageal fistula after thoracic aortic stent-graft placement: a rare but catastrophic complication of a novel emerging technique.JACC Cardiovasc Interv, vol. 2, no. 6, June 2009, pp. 570–76. Pubmed, doi:10.1016/j.jcin.2009.03.010.
Eggebrecht H, Mehta RH, Dechene A, Tsagakis K, Kühl H, Huptas S, Gerken G, Jakob HG, Erbel R. Aortoesophageal fistula after thoracic aortic stent-graft placement: a rare but catastrophic complication of a novel emerging technique. JACC Cardiovasc Interv. 2009 Jun;2(6):570–576.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

June 2009

Volume

2

Issue

6

Start / End Page

570 / 576

Location

United States

Related Subject Headings

  • Vascular Fistula
  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Stents
  • Middle Aged
  • Mediastinitis
  • Male
  • Inflammation Mediators
  • Humans
  • Hemorrhage