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Dysphagia aortica.

Serena Grimaldi1, Pamela Milito1, Andrea Lovece1

  • 1Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza Edmondo Malan, San Donato Milanese, 20097 Milan, Italy.

European Surgery : ACA : Acta Chirurgica Austriaca
|November 15, 2021
PubMed
Summary

Dysphagia aortica, caused by aortic compression, is a rare condition with high mortality. Early recognition and prompt treatment are crucial for improving patient outcomes in this challenging clinical scenario.

Keywords:
Aortic dysphagiaAortic pseudoanaeurysmAortoesophageal fistulaTEVARThoracic aortic aneurysm

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Area of Science:

  • Cardiology
  • Gastroenterology
  • Vascular Surgery

Background:

  • Dysphagia aortica describes swallowing obstruction due to external aortic compression from a dilated, tortuous, or aneurysmal aorta.
  • This condition is rare and presents significant challenges in diagnosis and management.

Purpose of the Study:

  • To clarify the clinical features and outcomes of patients diagnosed with dysphagia aortica.
  • To provide insights into the management and prognosis of this rare condition.

Main Methods:

  • A systematic literature review was conducted using major scientific databases (PubMed, EMBASE, Web of Science, Cochrane Library).
  • Search terms included "aortic dysphagia," "dysphagia aortica," and "dysphagia AND aortic aneurysm."
  • A prospectively updated esophageal center database was also queried for relevant cases over two decades.

Main Results:

  • A total of 70 patients (mean age 72 years, M:F ratio 1.1:1) were identified from 57 studies and the center's database.
  • 90% of patients had an aortic aneurysm, pseudoaneurysm, or dissection; 53% received operative treatment, with Thoracic Endovascular Aortic Repair (TEVAR) being common.
  • Postoperative mortality was 21.2% for treated patients and 55% for conservatively managed patients, with 45.6% of studies having a high risk of bias.

Conclusions:

  • Dysphagia aortica is a rare condition associated with high morbidity and mortality rates.
  • There is a lack of standardized management protocols for dysphagia aortica.
  • Early recognition of dysphagia and a high suspicion of aortoesophageal fistula are critical for potentially lifesaving interventions.