Esophageal Necrosis After Endoprosthesis for Ruptured Thoracoabdominal Aneurysm Type I: Can Long-Segment Stent Grafting of the Thoracoabdominal Aorta Induce Transmural Necrosis?

• Published in: Annals of vascular surgery Vol. 24; no. 8; pp. 1137.e7 - 1137.e12
• Main Authors: De Praetere, Herbert, Lerut, Philip, Johan, Mertens, Daenens, Kim, Houthoofd, Sabrina, Fourneau, Inge, Maleux, Geert, Lerut, Toni, Nevelsteen, Andre
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-11-2010
• Subjects: Aged; Aortic Aneurysm, Thoracic - complications; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - surgery; Aortic Rupture - diagnostic imaging; Aortic Rupture - etiology; Aortic Rupture - surgery; Aortography - methods; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Escherichia coli - isolation & purification; Esophagus - blood supply; Esophagus - pathology; Fatal Outcome; Humans; Ischemia - etiology; Ischemia - pathology; Male; Mediastinitis - microbiology; Necrosis; Sepsis - microbiology; Staphylococcus - isolation & purification; Surgery; Time Factors; Tomography, X-Ray Computed
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2010.04.007

Background To study the pathophysiology of esophageal necrosis after endoprosthesis was performed for a ruptured aneurysm and to define preventive measures and possible treatment options. Method A 72-year-old man with thoracoabdominal aneurysm type I and dysphagia underwent an emergent carotico-carotid bypass in combination with thoracic endovascular aortic aneurysm repair starting at a point distal to the brachiocephalic trunk and ending proximal to the superior mesenteric artery. On day 12, a decortication was performed for treating an infection in the remaining hematoma. However, further deterioration occurred as a result of mediastinitis secondary to the transmural necrosis of the middle third of the esophagus combined with accompanying mediastinitis. The patient’s family refused to give consent for further treatment by esophagectomy. He died 24 days after the initial operation. Conclusion Dysphagia aortica, mucosal abnormalities on esophagogastroscopy, and mediastinal compression by hematoma at the time of rupture draws our attention toward ischemia of the esophagus after thoracic endovascular aortic aneurysm repair. Repeated esophagoscopy can provide us with the opportunity to act before full thickness necrosis and mediastinitis occur.