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Aortoesophageal fistula: review of trends in the last decade

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Abstract

We reviewed articles on aortoesophageal fistula (AEF) published between January, 2009 and December, 2018. Postoperative aortic disease was the most common cause of AEF, followed by primary aortic aneurysm, bone ingestion, and thoracic cancer. Thoracic endovascular aortic repair (TEVAR) was the most common initial therapy for primary aortic disease, rather than graft replacement. Secondary AEF developed between 1 and 268 months, and between 1 and 11 months after the initial therapy for aortic disease and thoracic cancer, respectively. TEVAR trended to be preferred over surgery for aortic lesions because of its minimal invasiveness and certified hemostasis. In contrast, esophagectomy was preferred for esophageal lesions to remove the infectious source. A combination of surgery for the aorta (TEVAR, graft replacement or repair) and esophagus (esophagectomy, esophageal stent or repair) was usually adopted. Each graft replacement or esophagectomy was associated with a favorable prognosis for aortic or esophageal surgery, and the combination of graft replacement and esophagectomy generally improved the prognosis remarkably. Antibiotic therapy was given to 65 patients, with 20 receiving multiple antibiotics aimed at strong effects and the type of antibiotic described as broad-spectrum in 29 patients. Meropenem, vancomycin, and fluconazole were the most popular antibiotics used to prevent graft or stent infection. In conclusion, graft replacement and esophagectomy can achieve a favorable prognosis for patients with AEF, but strong, broad-spectrum antibiotic therapy might be required to prevent sepsis after surgery.

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Authors and Affiliations

  1. Department of Surgery, University of Miyazaki Hospital, Kihara 5200, Kiyotake-cho, Miyazaki City, Miyazaki, 889-1692, Japan

    Shinsuke Takeno, Hiroto Ishii, Atsushi Nanashima & Kunihide Nakamura

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  1. Shinsuke Takeno
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  2. Hiroto Ishii
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Correspondence to Shinsuke Takeno.

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We did not receive financial support from any organization to create the present study and report. Drs. Shinsuke Takeno, Hiroto Ishii, Atsushi Nanashima and Kunihide Nakamura have no conflicts of interest or financial ties to disclose.

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This report was approved by University of Miyazaki Hospital Clinical Research Assist Center. (No. C-0068) and in accordance with the 1964 Declaration of Helsinki and its later amendments.

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Takeno, S., Ishii, H., Nanashima, A. et al. Aortoesophageal fistula: review of trends in the last decade. Surg Today 50, 1551–1559 (2020). https://doi.org/10.1007/s00595-019-01937-z

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