Abstract | OBJECTIVES: BACKGROUND: Neurologic events are severe complications of TEVAR. With growing experience of TEVAR, other yet unexpected devastating complications have emerged. METHODS: Between July 1999 and August 2008, 268 patients underwent TEVAR for various thoracic aortic diseases at our institution. RESULTS: Six of 268 patients (age 49 to 77 years, 50% female patients) developed AEF (incidence 1.9%) within 1 to 16 months after the procedure. Indications for TEVAR were acute aortic dissection (n = 3), chronic aortic dissection (n = 1), and thoracic aortic aneurysm (n = 2). Four patients presented with sudden massive hematemesis whereas 2 patients were readmitted for new-onset fever and elevated markers of inflammation that preceded hematemesis. Esophago-gastro-duodenoscopy identified deep esophageal ulcerations at the level of the implanted aortic stent-graft in 4 patients, but only mild erosive lesions within the proximal esophagus without signs of active bleeding in the remaining 2 patients. Surgical repair was performed in only 1 patient and declined in the remaining because of comorbidities and multiorgan system failure. Despite this, all patients died due to fatal rebleeding (n = 4) or mediastinitis (n = 2). CONCLUSIONS:
AEF is a rare and unusual complication of TEVAR that occurs relatively early after the procedure and is almost invariably fatal. New-onset fever with elevated inflammatory markers or hematemesis should heighten clinical suspicion of AEF in TEVAR patients and prompt computed tomography or esophago-gastro-duodenoscopy in the hope of detecting, triaging, and treating this early to improve the otherwise dismal outcomes of these patients.
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Authors | Holger Eggebrecht, Rajendra H Mehta, Alexander Dechene, Konstantinos Tsagakis, Hilmar Kühl, Sebastian Huptas, Guido Gerken, Heinz G Jakob, Raimund Erbel |
Journal | JACC. Cardiovascular interventions
(JACC Cardiovasc Interv)
Vol. 2
Issue 6
Pg. 570-6
(Jun 2009)
ISSN: 1876-7605 [Electronic] United States |
PMID | 19539264
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Aged
- Aortic Dissection
(surgery)
- Aortic Aneurysm, Thoracic
(surgery)
- Aortic Diseases
(etiology, mortality, pathology, surgery)
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation
(adverse effects, instrumentation)
- Databases as Topic
- Endoscopy, Digestive System
- Esophageal Fistula
(etiology, mortality, surgery)
- Female
- Fever
(etiology)
- Hemorrhage
(etiology)
- Humans
- Inflammation Mediators
(blood)
- Male
- Mediastinitis
(etiology)
- Middle Aged
- Stents
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Fistula
(etiology, mortality, pathology, surgery)
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