Therapeutic strategy for treating aortoesophageal fistulas

Purpose The development fistulas between the thoracic aorta and the esophagus are highly fatal conditions. We aimed to identify a therapeutic strategy for treating aortoesophageal fistula (AEF) in this study, by investigating all AEF cases presented in this special symposium at the 65th Annual Scien...

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Published in:General thoracic and cardiovascular surgery 2014-10, Vol.62 (10), p.573-580
Main Authors: Akashi, Hidetoshi, Kawamoto, Shunsuke, Saiki, Yoshikatsu, Sakamoto, Tomohiko, Sawa, Yoshiki, Tsukube, Takuro, Kubota, Suguru, Matsui, Yoshiro, Karube, Norihisa, Imoto, Kiyotaka, Yamanaka, Katsuhiro, Kondo, Shunichi, Tobinaga, Satoru, Tanaka, Hiroyuki, Okita, Yutaka, Fujita, Hiromasa
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Aorta, Thoracic - surgery
Aortic aneurysms
Aortic Diseases - mortality
Aortic Diseases - surgery
Aortic dissection
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - methods
Blood Vessel Prosthesis Implantation - mortality
Cardiac Surgery
Cardiology
Coronary vessels
Cross-Sectional Studies
Current Topics Review Article
Endovascular Procedures - methods
Endovascular Procedures - mortality
Esophageal Fistula - mortality
Esophageal Fistula - surgery
Esophagectomy - methods
Esophagectomy - mortality
Esophagus
Etiology
Female
Fistula
Gender
Hospitals
Humans
Male
Medicine
Medicine & Public Health
Middle Aged
Mortality
Patients
Prostheses
Surgical Oncology
Thoracic Surgery
Transplantation, Homologous - methods
Transplantation, Homologous - mortality
Vascular Fistula - mortality
Vascular Fistula - surgery
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Summary:Purpose The development fistulas between the thoracic aorta and the esophagus are highly fatal conditions. We aimed to identify a therapeutic strategy for treating aortoesophageal fistula (AEF) in this study, by investigating all AEF cases presented in this special symposium at the 65th Annual Scientific Meeting of the Japanese Association for Thoracic Surgery. Methods Forty-seven AEF patients were included in this study. The survivors and nonsurvivors at six and 18 months after diagnosis of AEF were classified into “Group A6”, “Group D6”, “Group A18”, and “Group D18”, respectively. Comparisons between Group A6 and Group D6 and between Group A18 and Group D18 were made with regard to therapeutic strategy. Results Twenty-two (46.8 %) and 33 (70.3 %) of the 47 patients died within 6 and 18 months, respectively. The patients treated with omentum wrapping ( p  = 0.0052), esophagectomy ( p  = 0.0269) and a graft replacement strategy for the aorta ( p  = 0.002) were more frequently included in Group A6. The patients with the omentum wrapping ( p  = 0.0174) and esophagectomy ( p  = 0.0203) and graft replacement were more significantly included in Group A18. The results of the multivariate analysis indicated that the mortality rate at 6 and 18 months after diagnosis was significantly correlated with graft replacement ( p  = 0.0188) and esophagectomy ( p  = 0.0257), respectively. There were significant differences in the actuarial survival curves in patients who had omentum wrapping, graft replacement, and esophagectomy compared to patients who did not have these 3 therapeutic procedures. Conclusion The use of thoracic endovascular aortic repair alone for AEF should not be considered a definitive surgery. In contrast, esophagectomy, open surgery with aortic replacement using prostheses and homografts and greater omentum wrapping significantly improve the mid-term survival of AEF.
ISSN:1863-6705
1863-6713
DOI:10.1007/s11748-014-0452-4