胸主动脉瘤腔内隔绝术后远期主动脉食管瘘1例并文献复习

A case report of long term aortic esophageal fistula after endovascular isolation of thoracic aortic aneurysm and literature review

主动脉食管瘘(AEF)是一种罕见的疾病,误诊率及致死率高,可由胸主动脉瘤、异物摄入、主动脉支架置入腔内隔绝术(TEVAR)等引起。本病例2016年2月因胸背部疼痛就诊于四川省遂宁市中心医院(以下简称“我院”),经胸部增强CT检查诊断降主动脉瘤,行胸主动脉支架置入腔内隔绝术,术后半年复查发现Ⅰ型内漏,患者拒绝外科手术干预,4年后因心累、心悸再入我院,胸部增强CT提示AEF,拟行reTEVAR+食管重建杂交手术,患者拒绝手术,1个月后因出血及感染死亡。主动脉瘤支架置入远期发生AEF的病例极少。本文报道TEVAR术后远期AEF 1例,结合现有报道对其临床表现、诊断及治疗进行文献复习,以提高对该疾病的认识。

Aortoesophageal fistula(AEF)is a rare disease with high misdiagnosis rate and fatality rate,which can be caused by thoracic aortic aneurysm,foreign body intake,and thoracic endovascular aortic repair(TEVAR).This case was admitted to Suining Central Hospital(hereinafter referred to as“our hospital”)in February 2016 due to chest and back pain.The descending aortic aneurysm was diagnosed by chest enhanced CT examination,and endoluminal isolation was performed with thoracic aortic stent placement.The reexamination half a year after the operation revealed typeⅠleakage.The patient refused surgical intervention and was admitted to our hospital again four years later due to heart fatigue and palpitation.Chest enhanced CT suggested AEF,and reTEVAR+esophageal reconstruction hybrid surgery was planned.The patient refused the surgery and died due to bleeding and infection one month later.Long-term AEF of aortic aneurysm stent placement is rare.In this paper,a case of long-term AEF after TEVAR was reported.Combined with the existing reports,the clinical manifestations,diagnosis and treatment of this disease were reviewed in order to improve the understanding of this disease.