Aorto-conduit fistula developing four years after esophagectomy

Area of Science:

• Gastroenterology
• Cardiovascular Surgery
• Oncology

Background:

• Esophageal squamous cell carcinoma (ESCC) is a significant cause of cancer mortality.
• Ivor-Lewis esophagectomy is a standard surgical approach for ESCC.
• Complications following esophagectomy can be severe and challenging to manage.

Purpose of the Study:

• To report a rare but life-threatening complication of esophagectomy.
• To describe the successful endovascular management of an aorto-gastric fistula.
• To highlight the utility of thoracic aortic stents in managing complex post-surgical vascular issues.

Main Methods:

• A 71-year-old female patient with a history of ESCC treated with neoadjuvant chemotherapy and Ivor-Lewis esophagectomy.
• Presentation with massive bleeding due to a fistula between the thoracic aorta and gastric conduit.
• Successful treatment with a thoracic aortic stent placement.

Main Results:

• The patient experienced a rare aorto-gastric fistula four years post-esophagectomy.
• The fistula resulted in life-threatening hemorrhage.
• Endovascular repair with a thoracic aortic stent was technically successful and achieved hemostasis.

Conclusions:

• Aorto-gastric fistulas are a rare but critical complication after esophageal cancer surgery.
• Thoracic aortic stent-graft repair offers a minimally invasive and effective treatment for such fistulas.
• This case underscores the importance of considering endovascular options for complex vascular complications in oncologic surgery.