299. SURGICAL STRATEGY FOR THE TREATMENT OF AORTOESOPHAGEAL FISTULA

The number of thoracic endovascular aortic repair (TEVER) and artificial vessel replacement for thoracic aortic aneurysms is increasing. Aortoesophageal fistula (AEF) is one of the problems with long-term outcomes, and management of AEF needs immediate control of hemorrhage and infection. Bleeding control can be performed with artificial vessel replacement, but postoperative graft infection is inevitable in AEF. For infection control, removal of the diseased esophagus should be performed. In this study, we will clarify the surgical outcomes of esophagectomy for AEF.

We evaluated 22 patients who underwent artificial vascular replacement and esophagectomy for AEF from 2007 to 2023 at Kobe University Hospital, retrospectively. The surgical approaches for esophagectomy were left open thoracotomy, median sternotomy or minimally invasive esophagectomy (MIE).

In this study, all patients underwent simultaneous artificial vascular replacement and esophagectomy. According to the surgical approaches, 15 patients underwent left open thoracotomy, 6 patients underwent median sternotomy and 1 patient underwent left open thoracotomy + MIE. The male to female ratio was 15:7, and the median age was 72 (38-85) years. According to the type of reconstruction, 11 patients underwent pediculated jejunum reconstruction and 1 patient underwent ileocolic reconstruction. 12 patients (54.5%) were able to undergo reconstruction, 10 patients (45.5%) were not undergo reconstruction. 4 patients (18.2%) of died in the hospital.

Esophagectomy simultaneous with artificial vascular replacement could be a feasible treatment for AEF.