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Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection

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 g...

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Autores principales: Lee, Jae-Hong, Na, Bubse, Hwang, Yoohwa, Kim, Yong Han, Park, In Kyu, Kim, Kyung-Hwan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society for Thoracic and Cardiovascular Surgery 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4757400/
https://www.ncbi.nlm.nih.gov/pubmed/26889449
http://dx.doi.org/10.5090/kjtcs.2016.49.1.54
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author Lee, Jae-Hong
Na, Bubse
Hwang, Yoohwa
Kim, Yong Han
Park, In Kyu
Kim, Kyung-Hwan
author_facet Lee, Jae-Hong
Na, Bubse
Hwang, Yoohwa
Kim, Yong Han
Park, In Kyu
Kim, Kyung-Hwan
author_sort Lee, Jae-Hong
collection PubMed
description 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.
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spelling pubmed-47574002016-02-17 Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection Lee, Jae-Hong Na, Bubse Hwang, Yoohwa Kim, Yong Han Park, In Kyu Kim, Kyung-Hwan Korean J Thorac Cardiovasc Surg Case Report 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. The Korean Society for Thoracic and Cardiovascular Surgery 2016-02 2016-02-05 /pmc/articles/PMC4757400/ /pubmed/26889449 http://dx.doi.org/10.5090/kjtcs.2016.49.1.54 Text en Copyright © 2016 by The Korean Society for Thoracic and Cardiovascular Surgery. All rights Reserved. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Lee, Jae-Hong
Na, Bubse
Hwang, Yoohwa
Kim, Yong Han
Park, In Kyu
Kim, Kyung-Hwan
Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection
title Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection
title_full Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection
title_fullStr Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection
title_full_unstemmed Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection
title_short Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection
title_sort surgical management of aorto-esophageal fistula as a late complication after graft replacement for acute aortic dissection
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4757400/
https://www.ncbi.nlm.nih.gov/pubmed/26889449
http://dx.doi.org/10.5090/kjtcs.2016.49.1.54
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