Aortic arch debranching and extra-anatomic bypass for the surgical treatment of aortoesophageal fistula secondary to thoracic endovascular aortic repair.

BACKGROUND

Aortoesophageal fistula (AEF) is a relatively rare and life-threatening condition, and the optimal surgical treatment for secondary AEF following thoracic endovascular aortic repair (post-TEVAR AEF) remains controversial. This study aimed to summarize the clinical efficacy of aortic arch debranching combined with extra-anatomic bypass for the treatment of post-TEVAR AEF.

METHODS

The clinical data of 16 patients who underwent surgical treatment for post-TEVAR AEF at our institution from 30 June 2019 to 30 June 2024 were retrospectively reviewed. Aortic arch debranching and extra-anatomic aortic bypass under general anesthesia were performed for most patients. Empirical antibiotics were administered for 6-8 weeks. The acute and long-term outcomes were summarized.

RESULTS

Stent-related infection leading to AEF occurred at a median interval of 30 months after the initial TEVAR surgery. All patients presented with recurrent fever preoperatively; blood bacterial cultures were positive in nine patients (56.25%) and negative in seven patients (43.75%). The median operative time was 460.5 (433.5, 543.5) minutes, and the median intensive care unit stay was 7 (5.25, 31.75) days. No intraoperative mortality was observed in this cohort. During the follow-up period, three patients developed recurrent AEF accompanied by severe infection. Four patients died postoperatively, including one who died of thoracic aortic rupture and hemorrhage within 3 months postoperatively, and three others died of multiple organ failure at 4-10 weeks after surgery. The remaining 12 patients achieved favorable postoperative recovery without the need for prolonged antibiotic therapy.

CONCLUSION

Aortic arch debranching and extra-anatomic bypass from the ascending aorta to the proximal abdominal aorta yields favorable acute and long-term outcomes for patients with post-TEVAR AEF.