Korean J Thorac Cardiovasc Surg.  2016 Feb;49(1):54-58. 10.5090/kjtcs.2016.49.1.54.

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

• Lee JH
• Na B
• Hwang Y
• Kim YH
• Park IK
• Kim KH

• KMID: 2154339
• DOI: http://doi.org/10.5090/kjtcs.2016.49.1.54

Abstract

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.

Keyword

Fistula; Aorta; Surgery; Esophagus

MeSH Terms

Abscess
Aorta
Aorta, Thoracic
Brachiocephalic Trunk
Carotid Artery, Common
Chills
Drainage
Elephants
Esophagus
Fever
Fistula*
Follow-Up Studies
Humans
Male
Middle Aged
Subclavian Artery
Transplants*