RESUMO
BACKGROUND: Information regarding optimal revascularization and digestive tract repair in secondary aortoenteric fistula (sAEF) remains unclear. Thus, reporting treatment outcomes and presenting comprehensive patient details through a structured treatment approach are necessary to establish a treatment strategy for this rare, complex, and fatal condition. METHODS: We performed a single-center retrospective review of consecutive sAEF managed based on our in situ revascularization and intestinal repair strategy. The primary endpoint of this study was all-cause mortality, and secondary endpoints were the incidence of in-hospital complications and midterm reinfections. RESULTS: Between 2007 and 2020, 16 patients with sAEF, including 13 men (81%), underwent in situ revascularization and digestive tract repair. The median follow-up duration for all participants was 36 (interquartile range, 6-62) months. Among the participants, 81% (n = 13), 13% (n = 2), and 6% (n = 1) underwent aortic reconstruction with rifampin-soaked grafts, unsoaked Dacron grafts, and femoral veins, respectively. The duodenum was the most commonly involved site in enteric pathology (88%; n = 14), and 57% (n = 8) of duodenal breaks were repaired by a simple closure. Duodenum's second part-jejunum anastomosis was performed in 43% of patients (n = 6), and 19% of the patients (n = 3) died perioperatively. In-hospital complications occurred in 88% patients (n = 14), and the most frequent complication was gastrointestinal. Finally, 81% patients (n = 13) were discharged home. Oral antibiotics were administered for a median duration of 5.7 months postoperatively; subsequently, the participants were followed up carefully. Reinfection was detected in 6% of the patients (n = 1) who underwent reoperation without any complications. The 1-year and 3-year overall survival rates of participants were 75% (n = 12) and 75% (n = 9), respectively, and no sAEF-related deaths occurred, except perioperative death. CONCLUSIONS: Surgical intervention with contemporary management based on our vascular strategy and digestive tract procedure may be a durable treatment for sAEF.
Assuntos
Doenças da Aorta , Implante de Prótese Vascular , Fístula Intestinal , Fístula Vascular , Masculino , Humanos , Resultado do Tratamento , Prótese Vascular/efeitos adversos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Doenças da Aorta/complicações , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Estudos Retrospectivos , Duodeno/cirurgia , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Fístula Vascular/cirurgiaRESUMO
PURPOSE OF REVIEW: This review describes the presentation, diagnosis, and management of congenital coronary artery fistulas (CAFs) in adults. RECENT FINDINGS: CAFs are classified as coronary-cameral or coronary arteriovenous fistulas. Fistulous connections at the distal coronary bed are more likely to be aneurysmal with higher risk of thrombosis and myocardial infarction (MI). Medium-to-large or symptomatic CAFs can manifest as ischemia, heart failure, and arrhythmias. CAF closure is recommended when there are attributable symptoms or evidence of adverse coronary remodeling. Closure is usually achievable using transcatheter techniques, though large fistulas may require surgical ligation with bypass. Given their anatomic complexity, cardiac CT with multiplanar 3-D reconstruction can enhance procedural planning of CAF closure. Antiplatelet and anticoagulation are essential therapies in CAF management. CAFs are rare cardiac anomalies with variable presentations and complex anatomy. CAF management strategies include indefinite medical therapy, percutaneous or surgical CAF closure, and lifelong patient surveillance.
Assuntos
Anomalias dos Vasos Coronários , Humanos , Anomalias dos Vasos Coronários/terapia , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/cirurgia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Adulto , Fístula Arteriovenosa/terapia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/cirurgia , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Fístula Vascular/terapia , Fístula Vascular/cirurgia , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/diagnóstico , Cateterismo Cardíaco/métodosRESUMO
Aorto-esophageal fistula (AEF) due to esophageal cancer (EC) is a life-threatening condition characterized by sudden hemorrhage, which often causes sudden death. To evaluate the efficacy and safety of thoracic endovascular aortic repair (TEVAR) for AEF due to EC, we performed a systematic review and meta-analysis. We searched the MEDLINE (PubMed) databases, the Cochrane Library databases, Ichushi-Web (the databases of the Japan Medical Abstract Society), and CiNii (Academic information search service of the National Institute of Information from Japan) from January 2000 to November 2023 for articles about TEVAR for an emergent aortic hemorrhage (salvage TEVAR [S-TEVAR]), and the prophylactic procedure (P-TEVAR). Six studies (140 cases) were eligible for meta-analysis. The 90-day mortality of S-TEVAR and P-TEVAR was 40% (95% CI 23-60, I2 = 36%) and 8% (95% CI 3-17, I2 = 0%), respectively. Post-S-TEVAR hemorrhagic and infectious complications were 17% (95% CI 3-57, I2 = 71%) and 20% (95% CI 5-57, I2 = 66%), respectively. Post-P-TEVAR hemorrhagic and infectious complications were 2% (95% CI 0-10, I2 = 0%) and 3% (95% CI 1-12, I2 = 0%), respectively. TEVAR for AEF due to EC may be a useful therapeutic option to manage or prevent hemorrhagic oncological emergencies.
Assuntos
Aorta Torácica , Doenças da Aorta , Correção Endovascular de Aneurisma , Fístula Esofágica , Neoplasias Esofágicas , Fístula Vascular , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aorta Torácica/cirurgia , Doenças da Aorta/etiologia , Doenças da Aorta/cirurgia , Correção Endovascular de Aneurisma/efeitos adversos , Correção Endovascular de Aneurisma/métodos , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Neoplasias Esofágicas/cirurgia , Neoplasias Esofágicas/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Fístula Vascular/cirurgia , Fístula Vascular/etiologiaRESUMO
OBJECTIVE: Tracheoinnominate artery fistulas (TIFs) are a rare but deadly complication of tracheostomy. Tracheoinnominate artery fistula cases in the literature were summarized in order to understand mortality associations. METHODS: MEDLINE was searched for studies reporting individual characteristics of patients with TIFs after tracheostomy, excluding cases without tracheostomy or with additional procedures at the tracheostomy site. This study followed PRISMA guidelines. RESULTS: 121 TIF patients from 18 case series and 46 case reports were included. The median age was 40 years, and 52.9% were male. The overall mortality rate was 64.5%. There were differences in mortality between cases that presented initially with vs without sentinel bleeding (odds ratio [OR] .34; CI [confidence interval] .16-.73; P = .006). The mortality rate also differed in whether or not the tracheostomy cuff was over-inflated for temporary hemostasis during resuscitation (OR 3.57 (CI 1.57-8.09); P = .002). Treatment compared to no treatment had lower mortality rates (OR .11 (CI 0.04-.32); P < .001); no differences were found if treatment was endovascular vs open surgical. CONCLUSIONS: Mortality is a major concern after detection of a TIF and resuscitation paired with endovascular or open surgical intervention is imperative. Rapidly investigating sentinel bleeds and intervening upon hemorrhage with temporary cuff over inflation may lead to improved outcomes.
Assuntos
Traqueostomia , Fístula Vascular , Humanos , Masculino , Tronco Braquiocefálico/cirurgia , Complicações Pós-Operatórias/mortalidade , Doenças da Traqueia/etiologia , Doenças da Traqueia/mortalidade , Doenças da Traqueia/cirurgia , Traqueostomia/efeitos adversos , Traqueostomia/métodos , Fístula Vascular/mortalidade , Fístula Vascular/etiologia , Fístula Vascular/cirurgiaRESUMO
BACKGROUND: Aortoesophageal fistula (AEF) is a rare condition characterized by communication between the aorta and esophagus. AEF caused by an esophageal foreign body is even rare, and there is currently no recommended standard treatment protocol. We report a case of delayed aortic rupture after the endoscopic removal of a fish bone, which was successfully treated with a combined approach of vascular stenting and thoracic surgery. CASE PRESENTATION: A 33-year-old man presented to the hospital after experiencing chest discomfort for 3 days following the accidental ingestion of a fish bone. Under endoscopic guidance, the fish bone was successfully removed, and the patient was subsequently admitted for medical therapy. On the fourth postoperative day, the patient suddenly developed hematemesis, and chest computed tomography angiography revealed the presence of an AEF. This necessitated urgent intervention; hence, thoracic surgery was performed and a vascular-covered stent was placed. Following the surgical procedure, the patient received active medical treatment, recovered well, and was successfully discharged from the hospital. CONCLUSIONS: In patients with esophageal perforation caused by foreign bodies, hospitalization for observation, computed tomography angiography examination, early use of antibiotics, and careful assessment of aortic damage are advised. Thoracic endovascular aortic repair and esophageal rupture repair may have benefits for the treatment of AEF.
Assuntos
Doenças da Aorta , Fístula Esofágica , Fístula Vascular , Masculino , Animais , Humanos , Adulto , Cirurgia Torácica Vídeoassistida/efeitos adversos , Doenças da Aorta/cirurgia , Doenças da Aorta/complicações , Fístula Esofágica/cirurgia , Fístula Esofágica/complicações , Hemorragia Gastrointestinal , Stents/efeitos adversos , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Fístula Vascular/cirurgiaRESUMO
Pulmonary artery dissection is a rare and fatal disease. Diagnosis is mainly made during autopsy because most patients die suddenly due to pulmonary artery dissection in the pericardium resulting in pericardial tamponade. The optimum management is not clearly defined because of the paucity of cases in the literature. We describe the case of an 81-year-old man, affected by rheumatoid arthritis and with history of aortic valve replacement surgery, who attended an emergency department for non-specific symptoms, started complaining of chest pain rapidly deteriorated into cardiac shock. Computed tomography scan, performed on suspicion of an acute aortic pathology and/or a pulmonary embolism, allowed the identification of pulmonary artery dissection associated with aorto-pulmonary fistula. Despite early diagnosis in the emergency department, the outcome was unfortunately fatal.
Assuntos
Dissecção Aórtica , Artéria Pulmonar , Humanos , Idoso de 80 Anos ou mais , Masculino , Dissecção Aórtica/cirurgia , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Evolução Fatal , Tomografia Computadorizada por Raios X , Fístula Vascular/cirurgia , Fístula Vascular/diagnóstico , Fístula Vascular/diagnóstico por imagemRESUMO
We describe what we believe to be the first reported case of a neonate with right coronary ostial atresia with the right coronary artery originating from the left circumflex coronary artery, in conjunction with a right coronary artery to right ventricle fistula in a patient with otherwise normal cardiac anatomy. This was found following an evaluation for a continuous murmur at 2 weeks of life with elevated troponin and abnormal electrocardiogram. Thus far the child has required no intervention and is asymptomatic at 17 months of age, but he will require long-term follow-up to monitor the size of the fistula and potential for myocardial insufficiency.
Assuntos
Anomalias dos Vasos Coronários , Sopros Cardíacos , Humanos , Sopros Cardíacos/etiologia , Recém-Nascido , Masculino , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/complicações , Ventrículos do Coração/anormalidades , Eletrocardiografia , Fístula Vascular/complicações , Fístula Vascular/diagnóstico , Fístula Vascular/cirurgia , EcocardiografiaRESUMO
BACKGROUND: An aortoesophageal fistula can prove to be fatal. Salvage thoracic endovascular aortic repair as a bridging therapy and radical surgery with thoracotomy should be considered while treating aortoesophageal fistula without spontaneous closure. Moreover, it is essential to select a technique that reduces the risk of reinfection. Here we report a rare case of a ruptured thoracic aortic aneurysm related to esophageal perforation by a fish bone that led to massive hematemesis and shock, and the surgical treatment of an aortoesophageal fistula that developed after salvage thoracic endovascular aortic repair. CASE PRESENTATION: A 70-year-old Japanese female patient was admitted with hematemesis, thoracic pain, and shock related to esophageal perforation of a ruptured descending aortic aneurysm caused by fish bone aspiration and esophageal perforation 1 month previously. An emergency thoracic endovascular aortic repair was performed. Postoperatively, an aortoesophageal fistula that remained open and a food intake-related increase in the inflammatory response was noted. Radical blood-vessel prosthesis implantation and fistula closure were performed. The patient's postoperative course was favorable and the patient was discharged 22 days after the blood vessel prosthesis implantation. CONCLUSION: Such a case of rupture of a descending aortic aneurysm related to perforation by a fish bone and an aortoesophageal fistula is considerably rare. Thus, we report the therapeutic strategy of this particular case and review the relevant literature.
Assuntos
Aneurisma da Aorta Torácica , Ruptura Aórtica , Procedimentos Endovasculares , Fístula Esofágica , Perfuração Esofágica , Humanos , Feminino , Fístula Esofágica/cirurgia , Fístula Esofágica/etiologia , Idoso , Procedimentos Endovasculares/métodos , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Perfuração Esofágica/cirurgia , Perfuração Esofágica/etiologia , Fístula Vascular/cirurgia , Fístula Vascular/etiologia , Implante de Prótese Vascular , Terapia de Salvação/métodos , Animais , Hematemese/etiologia , Doenças da Aorta/cirurgia , Doenças da Aorta/etiologia , Aorta Torácica/cirurgia , Resultado do Tratamento , Peixes , Correção Endovascular de AneurismaRESUMO
Arterio-ureteral fistulas (AUFs), which are relatively rare but potentially life-threatening, require prompt diagnosis and treatment. We reported a case of AUFs following robot-assisted laparoscopic radical cystectomy (RARC) with extended pelvic lymph node dissection and ileal conduit urinary diversion for muscle-invasive bladder cancer, which resulted in massive hemorrhage. Urine leaked from the anastomosis between the ureter, and the end of the ileal conduit was infected, which resulted in an AUF between the pseudoaneurysm of the right common iliac artery and the ureter. The AUF was managed successfully by vascular intervention with an arterial stent graft.
Assuntos
Falso Aneurisma , Cistectomia , Artéria Ilíaca , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Doenças Ureterais , Fístula Urinária , Fístula Vascular , Humanos , Cistectomia/efeitos adversos , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Doenças Ureterais/etiologia , Doenças Ureterais/cirurgia , Artéria Ilíaca/cirurgia , Fístula Vascular/etiologia , Fístula Vascular/cirurgia , Masculino , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/etiologia , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Pessoa de Meia-IdadeRESUMO
A 72-year-old male with a history of a triple-vessel coronary artery bypass graft years ago presented with a DeBakey type 2 aortic dissection and an aorto-left atrial fistula with patent bypass grafts (left internal mammary artery and saphenous vein grafts). He developed pulmonary oedema and required intubation. The right axillary artery was cannulated. After the ascending aorta and left internal mammary artery were clamped, the aorta was transected, leaving aortic tissue around two saphenous vein grafts as two separate patches. An entry tear was found adjacent to the proximal anastomosis of the saphenous vein graft to the posterior descending artery. A fistula, which was located between a false lumen in the non-coronary sinus and the dome of the left atrium, was primarily closed. Because the adventitia was thinned out in the non-coronary sinus due to aortic dissection, partial aortic root remodelling was performed with resuspension of the commissures. Hemiarch repair was performed under moderate hypothermia and unilateral antegrade cerebral perfusion. After systemic perfusion was resumed, the locations of the saphenous vein graft buttons were determined. The ascending graft was cross-clamped again; the saphenous vein graft to the obtuse marginal branch graft was reimplanted using the Carrel patch technique while a saphenous vein graft to the posterior descending artery required interposition of a 10-mm Dacron graft to accommodate the length.
Assuntos
Dissecção Aórtica , Ponte de Artéria Coronária , Átrios do Coração , Humanos , Masculino , Idoso , Átrios do Coração/cirurgia , Dissecção Aórtica/cirurgia , Dissecção Aórtica/diagnóstico , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/efeitos adversos , Fístula Vascular/cirurgia , Fístula Vascular/etiologia , Fístula Vascular/diagnóstico , Fístula/cirurgia , Fístula/etiologia , Fístula/diagnóstico , Reoperação/métodos , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Veia Safena/transplanteRESUMO
BACKGROUND: Aortoesophageal fistula (AEF) is an extremely rare and highly fatal complication leading to a high risk of morbidity and mortality. Successful management of AEF after esophagectomy for esophageal carcinoma has rarely been reported in the literature. CASE PRESENTATION: Here we present a rare case of a 44-year-old female with complications of AEF after esophagectomy for esophageal carcinoma, mainly presented as vomiting of blood. Both computed tomographic and computed tomography angiography of the chest showed bilateral pleural effusion and atelectasis, while gastroscopy showed large gastrointestinal bleeding. Emergency surgery was performed that included the removal of the mediastinal abscess, left lower pulmonary wedge resection, and thoracic endovascular aortic repair (TEVAR), followed by supportive treatment. The surgery went successful, and the patient was followed up for 1 year after discharge and showed good recovery. We also reviewed previous literature on the history, causes, pathophysiology, clinical presentation, diagnosis, and treatment of AEF after esophagectomy for esophageal adenocarcinoma. CONCLUSIONS: In our case, thoracotomy combined with TEVAR was effective in treating AEF after esophagectomy for esophageal adenocarcinoma. This case provides successful experiences for clinical diagnosis and treatment of AEF after esophagectomy for esophageal carcinoma.
Assuntos
Adenocarcinoma , Doenças da Aorta , Carcinoma , Fístula Esofágica , Fístula Vascular , Adulto , Feminino , Humanos , Adenocarcinoma/cirurgia , Adenocarcinoma/complicações , Doenças da Aorta/cirurgia , Doenças da Aorta/complicações , Carcinoma/cirurgia , Correção Endovascular de Aneurisma , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Esofagectomia/efeitos adversos , Hemorragia Gastrointestinal , Fístula Vascular/etiologia , Fístula Vascular/cirurgiaRESUMO
BACKGROUND: We report a one-stage surgery to the case of secondary aortoenteric fistula (sAEF) after prosthetic reconstruction of abdominal aortic aneurysm, by multifaceted approach. CASE PRESENTATION: A 63-year-old male was admitted to our unit under diagnosed of sAEF after prosthetic reconstruction of abdominal aortic aneurysm, and a pseudoaneurysm of thoracoabdominal aorta due to infection. The patient underwent emergency operation. Firstly, we placed the patient in a modified right lateral decubitus position and performed thoracoabdominal aortic replacement with retroperitoneal approach by thoracoretroperitoneal incision which combined thoracotomy and pararectal incision, and secondly, we changed to a supine position and performed closure of the duodenal fistula and omental flap transposition by midline abdominal incision. The patient was doing well without complications. CONCLUSIONS: A one-stage, multifaceted surgical approach covering both prosthetic reconstruction of thoracoabdominal aorta and closure of sAEF with omentopexy is reasonable and useful strategy.
Assuntos
Aneurisma da Aorta Abdominal , Doenças da Aorta , Implante de Prótese Vascular , Duodenopatias , Fístula Intestinal , Ferida Cirúrgica , Fístula Vascular , Masculino , Humanos , Pessoa de Meia-Idade , Doenças da Aorta/cirurgia , Doenças da Aorta/etiologia , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/complicações , Aorta/cirurgia , Duodenopatias/complicações , Duodenopatias/cirurgia , Implante de Prótese Vascular/efeitos adversos , Fístula Vascular/cirurgia , Fístula Vascular/complicações , Aorta Abdominal/cirurgiaRESUMO
Aortic graft and endograft infections remain a significant source of morbidity and mortality after abdominal aortic aneurysm repair. With graft excision and extra-anatomic bypass, an infrarenal aortic stump remains which can have suture line dehiscence and catastrophic stump blowout. Treatment of this is extremely challenging, especially for severely co-morbid patients who cannot undergo major surgery, or in patients with a hostile abdomen. We present a case study of a 74-year-old male found to have an aortoenteric fistula (AEF). This case broadens operative options for this type of patient population by demonstrating an endovascular technique for addressing aortic stump blowout by parallel grafting and coil embolization of the visceral aorta.
Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Prótese Vascular , Embolização Terapêutica , Procedimentos Endovasculares , Fístula Intestinal , Fístula Vascular , Humanos , Masculino , Idoso , Embolização Terapêutica/instrumentação , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/efeitos adversos , Resultado do Tratamento , Procedimentos Endovasculares/instrumentação , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Fístula Vascular/cirurgia , Fístula Vascular/terapia , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , Fístula Intestinal/terapia , Aortografia , Angiografia por Tomografia Computadorizada , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgiaAssuntos
Aneurisma Coronário , Doença da Artéria Coronariana , Fístula , Fístula Vascular , Humanos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Aneurisma Coronário/complicações , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/cirurgia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Fístula/diagnóstico por imagem , Fístula/cirurgia , Angiografia Coronária , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgiaRESUMO
Resumo A fístula aortoentérica é uma grave condição clínica, e seu manejo permanece sendo um grande desafio técnico aos cirurgiões. A abordagem por cirurgia convencional nesses casos está relacionada a altos índices de morbimortalidade. A cirurgia endovascular apresenta-se como uma ótima alternativa nesses casos; contudo, por não se tratar de aorta nativa, a anatomia pode não ser compatível com os dispositivos endovasculares comercialmente disponíveis, fazendo-se necessário, em casos de urgência, a utilização de dispositivos modificados pelo cirurgião. O caso relatado reporta uma fístula aortoentérica secundária, tratada em situação de urgência por técnica endovascular com dispositivo modificado.
Abstract Aortoenteric fistula is a severe clinical condition and its management remains a major technical challenge for surgeons. In these cases, the conventional surgical approach is associated with high rates of morbidity and mortality. Endovascular surgery is an excellent option in these cases, but considering that the aorta has been treated previously, anatomy may not be compatible with commercially available endovascular devices and so physician-modified endografts may be needed in urgent cases. The case reported involves a secondary aortoenteric fistula, treated on an emergency basis with endovascular techniques, using a physician-modified endograft.
Assuntos
Humanos , Masculino , Idoso , Próteses e Implantes , Fístula Vascular/cirurgia , Procedimentos Endovasculares/instrumentação , Aneurisma Aórtico/cirurgia , Emergências , Procedimentos Endovasculares/métodosRESUMO
Primary aortoenteric fistula is the spontaneous communication between the lumen of the aorta and a portion of the digestive tract. The most common cause is the erosion of an abdominal aortic aneurysm into the 3rd or 4th portion of the duodenum. It manifests clinically as gastrointestinal bleeding, with or without abdominal pain and a pulsatile abdominal mass on physical exam. Gastrointestinal bleeding is initially recurrent and self-limiting and progresses to fatal exsanguinating hemorrhage. Endoscopic examination diagnoses only 25% of aortoenteric fistulas because these are usually located in the distal duodenum. Contrast computed tomography of the abdomen and pelvis is diagnostic in only 60% of cases. We report three cases with this condition. A 67-year-old male presenting with an upper gastrointestinal bleeding. He was operated and a communication between an aortic aneurysm and the duodenum was found and surgically repaired. The patient is well. A 67-year-old male with an abdominal aortic aneurysm presenting with abdominal pain. He was operated and anticoagulated. In the postoperative period he had a massive gastrointestinal bleeding and a new CAT scan revealed an aorto enteric fistula that was surgically repaired. The patient is well. An 82-year-old male with an abdominal aortic aneurysm presenting with hematochezia. A CAT scan revealed a communication between the aneurysm and the third portion of the duodenum, that was surgically repaired. The patient died in the eighth postoperative day.
Assuntos
Humanos , Masculino , Doenças da Aorta , Ruptura Aórtica , Fístula Vascular/cirurgia , Fístula Vascular/complicações , Fístula Vascular/diagnóstico por imagem , Fístula Intestinal/complicações , Fístula Intestinal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Duodenopatias/cirurgia , Duodenopatias/complicações , Duodenopatias/diagnóstico por imagem , Aorta Abdominal , Duodeno , Hemorragia Gastrointestinal/etiologiaRESUMO
No disponible
Assuntos
Humanos , Feminino , Idoso , Dispositivos de Oclusão Vascular , Fístula Vascular/cirurgia , Impressão Tridimensional , Doença IatrogênicaRESUMO
Abstract Six months after undergoing a Fontan operation, a 7-year-old boy with right atrial isomerism and a single functional ventricle was admitted to our emergency department with cyanosis. Emergency cardiac catheterization revealed a large veno-venous fistula that began in a left hepatic vein, connected to the left accessory hepatic veins, and drained into the common atrium, resulting in desaturation. The fistula was occluded proximally with an Amplatzer septal occluder, with satisfying results; the patient's systemic arterial saturation decreased during his hospital stay. Three weeks after the first intervention, a second procedure was performed to retrieve the first device and to close the fistula distally. Multiple attempts with different types of gooseneck snares and a bioptome catheter failed to retrieve the first device, so a telescopic method was used to re-screw it. Using a Mullins long sheath and delivery sheath, the delivery cable was manipulated to fit into the slot of the end screw, and the cable was rotated gently in a clockwise direction to re-screw the device. Then, another Amplatzer septal occluder was placed at the distal end of the fistula. In conclusion, distal transcatheter occlusion of intrahepatic veno-venous fistulas might lead to better clinical outcomes in selected patients. Amplatzer septal occluder device can be retrieve without any complication within three weeks.