[Open Repair of the Thoracic Aorta Using the Clamshell Approach Because of Aortooesopheagel Fistula - a Multidisciplinary Approach].

Abstract:

INTRODUCTION:Aortoesophageal fistula (AEF) following open or endovascular operations of the thoracoabdominal aorta is a rare, yet life-threatening condition. In this case, the whole thoracic aorta has to be replaced using a "clamshell approach" because of an AEF following open repair of the ascending aorta after type A dissection and a thoracic endovascular aortic repair (TEVAR). CASE REPORT:In 2015 a 43-year old woman suffered a type A dissection and underwent open supracoronary ascending aortic replacement including the proximal aortic arch. In 2016, she developed severe haemoptysis. An AEF could be detected and TEVAR was performed as emergency treatment. The further steps of the repair included oesophagectomy and repair of the whole thoracic aorta using a transverse thoracotomy - a clamshell approach. CONCLUSION:The curative treatment of AEF, which is based on radical, open repair of the oesophagus and the involved aortic segments, is challenging. A clamshell approach is a feasible option when replacement of the whole thoracic aorta is required. EINLEITUNG:Aortoösophageale Fisteln infolge offener und endovaskulärer Operationen der thorakoabdominellen Aorta sind seltene und lebensbedrohliche Erkrankungen. Im vorliegenden Fall war durch die infektiöse Mitbeteiligung einer einliegenden Ascendens-Bogenprothese sowie einer thorakalen Endoprothese im Bereich der Aorta descendens der vollständige Ersatz der thorakalen Aorta über einen sog. „clamshell“-Zugang notwendig. KASUISTIK:Bei einer Aortendissektion Typ A nach Stanford erfolgte bei einer 43-jährigen Patientin 2015 ein suprakoronarer Aortenersatz. 2016 wurde bei aortoösophagealer Fistel mit schweren Hämoptysen notfallmäßig eine thorakale Stentprothese (TEVAR) implantiert. Zur definitiven Versorgung mit Entfernung des infizierten Prothesenmaterials erfolgte ein vollständiger Ersatz der thorakalen Aorta im Rahmen einer queren Thorakotomie als Teil eines multimodalen Therapiekonzeptes. Bereits vorab war eine Ösophagektomie erfolgt; abschließend wurde die Passage mittels eines sekundären antesternalen Magenhochzugs rekonstruiert. SCHLUSSFOLGERUNG:Aortoösophageale Fisteln stellen eine therapeutische Herausforderung dar, die in Referenzzentren durch ein interdisziplinäres Team behandelt werden sollten. Der „clamshell“-Zugang mittels querer Thorakotomie ermöglichte im vorliegenden Fall den Ersatz der gesamten thorakalen Aorta.

journal_name

Zentralbl Chir

authors

Gombert A,Grommes J,Kotelis D,Jacobs MJ

doi

10.1055/a-0713-0457

subject

Has Abstract

pub_date

2018-10-01 00:00:00

pages

475-479

issue

5

eissn

0044-409X

issn

1438-9592

journal_volume

143

pub_type

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