Emergency aortic stent-graft treatment in patients with malignant aorto-esophageal fistula is worthwhile

Abstract

Aim: To investigate the outcome of emergency aorticstent-graft treatment in patients with malignant aorto-esophageal fistula (AEF). Methods: Two patients with advanced squamous cellcarcinoma of the mid-esophagus were reported.Both patients had esophageal stents in-situ anddeveloped sudden onset massive haematemesis and haemodynamic instability due to primary AEF. Anelectronic search was performed to identify similar published case reports. A case series was con-structed with comparison on the patient’s demographics, tumour status, operation performed,clinical outcome and survival. Results: Six patients with malignant AEF werereported in this series. Hemostas is was successfully achieved with endovascular aortic stent-graft in allpatients. On average, the patients survived for morethan three months after the operation with no furtherseptic or haemorrhagic complications. Five out of sixpatients finally passed away due to terminal malig-nancy while one patient survived with good recovery. Conclusion: We emphasize that even when theesophageal tumours are locally advanced, TEVAR(Thoracic endovascular aortic stent-graft repair) should be regarded as the first line treatment of AEFas supported by its relatively low operative mortality and effective control of massive hematemesis. A rea-sonable prolongation of survival could be achieved even in patients with malignant AEF.