New insights regarding the incidence, presentation and treatment options of aorto-oesophageal fistulation after thoracic endovascular aortic repair: The european registry of endovascular aortic repair complications

Martin Czerny, Holger Eggebrecht, Gottfried Sodeck, Ernst Weigang, Ugolino Livi, Fabio Verzini, Jürg Schmidli, Roberto Chiesa, Germano Melissano, Andrea Kahlberg, Philippe Amabile, Wolfgang Harringer, Michael Horacek, Raimund Erbel, Kay Hyun Park, Friedhelm Beyersdorf, Bartosz Rylski, Philipp Blanke, Ludovic Canaud, Ali KhoynezhadLars Lonn, Hervè Rousseau, Santi Trimarchi, Jan Brunkwall, Michael Gawenda, Zhihui Dong, Weiguo Fu, Ingrid Schuster, Michael Grimm

Research output: Contribution to journalArticle

Abstract

Objectives: To review the incidence, clinical presentation, definite management and 1-year outcome in patients with aorto-oesophageal fistulation (AOF) following thoracic endovascular aortic repair (TEVAR). Methods: International multicentre registry (European Registry of Endovascular Aortic Repair Complications) between 2001 and 2011 with a total caseload of 2387 TEVAR procedures (17 centres). Results: Thirty-six patients with a median age of 69 years (IQR 56-75), 25% females and 9 patients (19%) following previous aortic surgery were identified. The incidence of AOF in the entire cohort after TEVAR in the study period was 1.5%. The primary underlying aortic pathology for TEVAR was atherosclerotic aneurysm formation in 53% of patients and the median time to development of AOF was 90 days (IQR 30-150). Leading clinical symptoms were fever of unknown origin in 29 (81%), haematemesis in 19 (53%) and shock in 8 (22%) patients. Diagnosis could be confirmed via computed tomography in 92% of the cases with the leading sign of a new mediastinal mass in 28 (78%) patients. A conservative approach resulted in a 100% 1-year mortality, and 1-year survival for an oesophageal stenting-only approach was 17%. Survival after isolated oesophagectomy was 43%. The highest 1-year survival rate (46%) could be achieved via an aggressive treatment including radical oesophagectomy and aortic replacement [relative risk increase 1.73 95% confidence interval (CI) 1.03-2.92]. The survival advantage of this aggressive treatment modality could be confirmed in bootstrap analysis (95% CI 1.11-3.33). Conclusions: The development of AOF is a rare but lethal complication after TEVAR, being associated with the need for emergency TEVAR as well as mediastinal haematoma formation. The only durable and successful approach to cure the disease is radical oesophagectomy and extensive aortic reconstruction. These findings may serve as a decision-making tool for physicians treating these complex patients.

Original languageEnglish
Article numberezt393
Pages (from-to)452-457
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume45
Issue number3
DOIs
Publication statusPublished - Mar 2014

Keywords

  • Aorto-oesophageal fistulation
  • Complications
  • Thoracic endovascular aortic repair
  • Treatment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

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    Czerny, M., Eggebrecht, H., Sodeck, G., Weigang, E., Livi, U., Verzini, F., Schmidli, J., Chiesa, R., Melissano, G., Kahlberg, A., Amabile, P., Harringer, W., Horacek, M., Erbel, R., Park, K. H., Beyersdorf, F., Rylski, B., Blanke, P., Canaud, L., ... Grimm, M. (2014). New insights regarding the incidence, presentation and treatment options of aorto-oesophageal fistulation after thoracic endovascular aortic repair: The european registry of endovascular aortic repair complications. European Journal of Cardio-thoracic Surgery, 45(3), 452-457. [ezt393]. https://doi.org/10.1093/ejcts/ezt393