The life-saving emergency thoracic endovascular aorta repair management on suspected aortoesophageal foreign body injury

doi:10.5847/wjem.j.1920-8642.2020.03.004

Abstract

Abstract:

BACKGROUND: Fatal aortic rupture caused by esophageal foreign body (EFB), is associated with a high mortality, but can be prevented by thoracic endovascular aorta repair (TEVAR) that performed increasingly as technology improves. This study aims to investigate the cause, management and prognosis of suspected penetrating aortoesophageal foreign body injury.

METHODS: Twelve cases who met the criteria were enrolled in this study. The demographic and clinical data were reviewed for evaluating the characteristics of EFB.

RESULTS: Among 12 cases enrolled, 7 were males and 5 were females, with an age 27-86 years. The distance of EFB from aorta (DFA) of 7 cases were less than or equal to 0 mm, 5 cases were 0-2 mm. Eleven cases were managed with TEVAR, only one case was with open surgery standby but finally treated by flexible endoscopy (FE) successfully, without TEVAR. In group with TEVAR, EFB of 7 cases were successfully removed by rigid endoscopy (RE), and one of them was failed at the first RE treatment. EFB of 2 cases were successfully removed by open surgery with TEVAR, and other 9 cases were managed by endoscopies with TEVAR. The mean length of stay of hospitalization (LOS) and length of ICU stay of patients treated by open surgery with TEVAR (18.50±2.12 days and 5.50±0.71 days) was significantly longer than those of patients treated by endoscopy with TEVAR (7.00±2.74 days and 1.33±1.12 days, P<0.001 and P=0.001, respectively). Five cases had severe complications.

CONCLUSION: Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury, and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.

Key words: Aortoesophageal foreign body injury, Thoracic endovascular aorta repair

Wei-shuyi Ruan, Yuan-qiang Lu. The life-saving emergency thoracic endovascular aorta repair management on suspected aortoesophageal foreign body injury[J]. World Journal of Emergency Medicine, 2020, 11(3): 152-156.

Figures/Tables 3

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Figure 1.

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No.	Clinical characteristics							EFB characteristics
No.	Gender /Age(year)	Basal disease	Clinical symptoms	T (°C)	BP (mmHg)	WBC (×10⁹/L)	DOI (hours)	Type	Shape	L_max(mm) /L_min(mm)	DFI (cm)
1	Male/40	-	Fever and odynophagia and retrosternal pain	37.5	112/71	10.5	20	Crab shell	Pin-like	29/2	29
2	Female/67	Paroxysmal atrial fibrillation	Retrosternal pain and acid regurgitation	37	179/84	7.7	24	Fish bone	Pin-like	27/2	24
3	Female/63	Breast cancer, cholecystitis	Retrosternal pain	36.8	175/86	7.3	4	Fish bone	Sheet	20/20	23
4	Female/53	Diabetes	Retrosternal pain	36.4	172/82	6.7	24	Fish bone	Pin-like	30/2	27
5	Male/65	Hypertension	Odynophagia	36.2	136/86	8.8	120	Fish bone	Sheet	30/25	25
6	Male/65	Hypertension	Retrosternal pain	36.6	142/52	9	24	Fish bone	Sheet	25/20	23
7	Male/31	-	Fever and odynophagia and retrosternal pain	38.5	121/73	12	10	Foil shell of a pill	Irregular	25/15	22
8	Male/86	Hypertension	Odynophagia and retrosternal pain	36.9	120/62	10.1	312	Pork bone	Sheet	31/15	24
9	Male/48	-	Retrosternal pain	36.9	136/90	9.6	22	Fish bone	Pin-like	30/3	35
10	Female/51	-	Odynophagia and retrosternal pain	37	118/80	12.9	48	Fish bone	Pin-like	25/3	28
11	Male/33	-	Fever and abdominal pain	37.6	139/73	15.8	48	Fish bone	Pin-like	30/5	40
12	Female/27	-	Retrosternal pain	36.8	113/74	5.1	4	Poultry bone	Sheet	35/15	24

No.	DFA (mm)	TAVER	Stent size (mm)	Remove treatment	ICU (days)	LOS (days)	Severe complications	30-day mortality
1	0	+	20×160	RE	-	8	-	Survive
2	0	+	30×160	FE	2	9	-	Survive
3	0	+	30×200	FE	4	11	Pneumonia	Survive
4	2	+	28×160	RE	1	7	-	Survive
5	2	+	34×160	RE	1	6	Pleural effusion	Survive
6	1	+	30×160	RE	1	2	-	Survive
7	1	+	28×160 in trunk 10×50 in subclavian artery	RE	1	7	-	Survive
8	0	+	28×160	RE	1	9	Pleural effusion	Survive
9	0	+	31×150	RE twice (open surgery standby)	-	4	-	Survive
10	0	+	28×150	Open surgery	6	17	Pleural effusion	Survive
11	0	+	28×160	FE failed, then open surgery	5	20	Mediastinitis and pneumonia	Survive
12	3	-	-	FE (open surgery standby)	-	2	-	Survive