RESUMO
Secondary aortoesophageal fistula is a relatively rare but very often lethal complication that may develop after thoracic endovascular aneurysm repair (TEVAR). The clinical syndrome is well explained by the Chiari triad: midthoracic pain and/or dysphagia, and sentinel minor hematemesis followed by massive hematemesis. The incidence of this serious complication has increased with the growing number of patients undergoing TEVAR. This case report describes a patient who was seen in the emergency department at this hospital because of fever, sepsis and thoracic pain radiating to the back and unresponsive to drug therapy, diagnosed with a secondary aortoesophageal fistula and subsequently treated with a two stage surgical procedure.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/efeitos adversos , Remoção de Dispositivo , Procedimentos Cirúrgicos do Sistema Digestório , Procedimentos Endovasculares/efeitos adversos , Fístula Esofágica/cirurgia , Fístula/cirurgia , Idoso , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/etiologia , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/etiologia , Esofagostomia , Fístula/diagnóstico por imagem , Fístula/etiologia , Humanos , Jejunostomia , Masculino , Reoperação , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A 62-year-old man was incidentally diagnosed with a completely asymptomatic aberrant right subclavian artery (ARSA) aneurysm with a maximum diameter of 4.5 cm. This condition presents a postrupture mortality rate of 50% and the morbidity-mortality rates reported in the literature with traditional open repair procedures are of 25%. In our patient we planned a hybrid procedure and excluded the aneurysm by performing, first, a right carotid-subclavian bypass with ligation of the subclavian artery upstream from the vertebral artery and the internal mammary artery and, the day after, by covering its origin from the aortic arch with the placement of a thoracic endoprosthesis. A third session was necessary, three days later, because of a leak; a complete resolution of the condition was achieved by embolizing the still perfused residual aneurysmal sac with Balt metallic coils.