A Hole in the Soul: A Rare Complication Post TEVAR 1812

• Published in: The American journal of gastroenterology Vol. 113; no. Supplement; pp. S1030 - S1031
• Main Authors: Altamimi, Barakat Aburajab, Niyazi, Fadi, El Abiad, Rami
• Format: Journal Article
• Language: English
• Published: New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.10.2018
• Subjects: Aneurysms; Esophagus; Fistula; Gastroenterology; Ostomy
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/00000434-201810001-01812

Thoracic endovascular aortic repair (TEVAR) is a minimally invasive approach through which a stentgraft is placed into the thoracic or thoracoabdominal aorta to treat a variety of thoracic aortic pathologies. This case highlights a rare complication of TEVAR. 70-year-old female with history of hypertension and descending thoracic aortic aneurysm S/P TEVAR presented after one month from her surgery with two weeks of chest pain. The pain was throbbing, constant and not associated with any activity or exertion, it radiated to the back. On CT scan done for followup she was noted to have perianeurysmal air in the mediastinum. She did not have any hemoptysis, hematemesis, fever, chills, shortness of breath, cough, syncope or dizziness. Patient had an EGD done which showed a perforation extending from 26 cm to 28 cm from the incisors with visible vascular graft. No associated mass lesion was seen. Patient went to the OR the next day with aortic graft explant and placement of homograft, esophageal perforation primary repair with intercostal muscle patch and jejunostomy. Graft cultures that were removed grew Strep anginosus, Strep oralis/mitis, and Candida albicans. Patient was placed on antibiotics for 6 weeks . A week after surgery esophagram was done that did not show any leakage after which the patient was discharged. Aortoesophageal fistula (AEF) is a catastrophic complication of TEVAR. Conservative treatment is often associated with poor outcome. Fatal complications occurred in 4 percent, including rupture of the treated aneurysm, stentgraft erosion into the esophagus (AEF), arterial injury, and excessive bleeding. In cases of bleeding it might be beneficial to place esophageal stent that would allow for resuscitation prior to definitive therapy with vascular repair. Of note one of the complications of AEF is esophageal sepsis as demonstrated above. Aortoesophageal fistula is a fatal complication that can occur for TEVAR. EGD needed for definitive diagnosis. Early recognition and surgical intervention are associated with decrease in morbidity and mortality.