Search

Background: Aortoesophageal fistula (AEF) is a rare but fatal condition causing massive upper gastrointestinal bleeding.Purpose: To report our experiences in the management of life-threatening AEF.Material and Methods: A total of eight patients (seven men, one woman; mean age = 59.4 years; age range = 43‒76 years) presenting with AEF between 2005 and 2018 were recruited from three different Korean hospitals. The medical records of these patients were reviewed for patient demographics, clinical features, diagnostic and therapeutic modalities, and outcomes.Results: Two patients died as a result of massive hemorrhage before endovascular or surgical treatment could be undertaken. Of the six patients who were treated, five underwent endovascular interventions: embolization of the fistula using n-butyl cyanoacrylate (NBCA) and subsequent thoracic endovascular aortic repair (TEVAR) in two patients; TEVAR alone in two patients; and NBCA embolization alone in one patient. Among them, three patients who received TEVAR with or without NBCA embolization in a timely fashion recovered and were discharged. One patient who received delayed TEVAR died of disseminated intravascular coagulation, and one who received NBCA embolization alone died of hemorrhagic shock, both dying within three days of treatment. The remaining patient who underwent surgical aortic repair is alive after 13 years.Conclusion: Rapid identification and surgical treatment are necessary to increase the likelihood of survival, if emergency surgery is feasible. TEVAR in a timely fashion facilitates hemodynamic stabilization by rapidly controlling hemorrhage and saves the patient's life. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to analyze computed tomography (CT) findings and medical records of patients diagnosed with median arcuate ligament syndrome (MALS) and evaluate possible risk factors associated with vascular complications that develop in patients with MALS.Methods: This retrospective study was approved by the institutional review board, and the requirement to obtain informed consent was waived. A total of 37 consecutive patients were diagnosed with MALS using both axial and sagittal CT reconstruction imaging at a single institution over a 7-year period. Dynamic contrast-enhanced CT data, medical records, and angiography results were reviewed.Results: Thirty-two (86.5%) patients were asymptomatic and incidentally diagnosed with MALS using CT. Seventeen (45.9%) patients exhibited significant arterial collateral circulations and nine (24.3%) were found to have splanchnic artery aneurysms, including one (2.7%) with acute bleeding secondary to aneurysm rupture. Peripancreatic vascular network including pancreaticoduodenal arcades and dorsal pancreatic artery was the most common site for development of both collateral circulations (16/22, 72.7%) and aneurysms (9/16, 56.3%). Splanchnic artery aneurysms were significantly more common in patients with collateral circulations (8/17, 47.1%) compared with those without collateral circulations (1/20, 5%) (P < 0.01). At least one peripancreatic vascular aneurysm was found in five of nine patients with splanchnic artery aneurysms (55.6%).Conclusion: Splanchnic artery aneurysms are not uncommon in asymptomatic patients with collateral circulations caused by significant celiac trunk stenosis or obstruction due to median arcuate ligament. Therefore, careful imaging evaluation is necessary in patients with peripancreatic collateral circulations associated with MALS and regular follow-up is recommended for possibility of aneurysm development and rupture. Prophylactic endovascular treatment should be specifically performed in patients with pancreaticoduodenal arcade aneurysms to prevent life-threatening aneurysm rupture regardless of size. [ABSTRACT FROM AUTHOR]