Emergency Endovascular Treatment of An Aortoesophageal Fistula with Torrential Bleeding After Mediastinal Mass Resection

ABS TRACT A 67 ye ars old fe ma le pa ti ent was ad mit ted to the emer gency ro om with acu te mas si ve gas tro in tes ti nal he morr ha ge. She had be en ope ra ted for the re sec ti on of a me di as ti nal sar co ma 3 we eks be fo re. A seg ment of the esop ha gus had be en re sec ted wit hin the tu mor and was re a nas to mo sed in an end-to-end fas hi on. In light of the pre vi o us his tory, an aor to-esop ha ge al fis tu la (AEF) was sus pec ted. Emer gent en dos copy re ve a led mas si ve clots and ac ti ve ble e ding at the le vel of the esop ha ge al anas to mo sis. CT al so re ve a led con trast ex tra va sa ti on in to the esop ha gus. The esop ha ge al si de of the de fect was con trol led by inf la ti on of the esop ha ge al bal lo on of a Seng sta ken-Bla ke mo re tu be. Then the AEF was to tally con trol led by imp lan ta ti on of an aor tic en do vas cu lar stent-graft. The pa ti ent had no gas tro in tes ti nal he morr ha ge un til she di ed of pne u mo ni a 30 days la ter. Aor to-esop ha ge al fis tu la re ma ins to be a highly let hal comp li ca ti on of tho ra cic sur gery. En do vas cu lar stent imp lan ta ti on wit hin the aor ta is a fast and ef fec ti ve tech ni qu e to con trol the mas si ve ble e ding, but ot her risks such as li fe-thre a te ning in fec ti ons re ma in un til de fi ni ti ve the rapy may be ac hi e ved.