Carotid Cut-Down for Covered Stent Treatment of Descending Thoracic Aorta Pseudoaneurysm and Aorto-Esophageal Fistula.

BACKGROUND

Aorto-enteric fistulae are rare in children and associated with an immediate risk of hemorrhage and death. Contrast-enhanced computed tomography angiography is first-line when an aortic source is suspected. Management is challenging in children because of patient size and mediastinal contamination.

CASE SUMMARY: A 1-year-old, previously well girl presented with fever, massive hematemesis, and hemorrhagic shock requiring intubation, transfusion, and ongoing volume resuscitation. Computed tomography angiography demonstrated localized, saccular descending thoracic aortic pathology. Emergency aneurysm exclusion via left carotid cut-down and covered Cheatham-Platinum stent implantation was performed with rapid right ventricular pacing, achieving complete angiographic exclusion. Hematemesis did not recur. Postprocedure care included bowel rest, total parenteral nutrition, and prolonged broad-spectrum antimicrobial therapy. Feeding was initiated after a normal upper gastrointestinal contrast study.

CONCLUSION

In children with suspected aorto-enteric fistulas and life-threatening hemorrhage, a hybrid approach for covered stent deployment can provide rapid, definitive aortic source control when emergency open repair is high risk or not immediately feasible.