Management of Tumor- and Non-Tumor-related Aorto-esophageal and Aorto-bronchial fistulas.

Abstract Objectives This study aims to review and compare the clinical presentation, management, and outcome in patients with tumor-related (TR) and non-tumor-related (NTR) aorto-esophageal (AEF) and aorto-bronchial fistulas (ABF) with particular focus on the thoracic endovascular aortic repair. Methods We retrospectively reviewed a series of 16 consecutive patients with TR (n=8) and NTR (n=8), ABF (n=6), and AEF (n=10) admitted to our hospital from 2011 to 2019. Results The median age was 62 years (range 46-81), with 11 men. The most common predisposing factor was esophageal or gastric cardia cancer (n=6), followed by open repair of the thoracic aorta (n=5). Endoluminal vacuum therapy (Endo-SPONGE®) accounted for three cases of AEFs. TEVAR was applied in 13 patients (4 with ABFs and 9 with AEFs). The primary technical success of the TEVARs was 100%. One patient (8%) was complicated with postoperative middle cerebral artery syndrome and left-sided hemiparesis. The respective in-hospital-, 6-month-, and 1-year-mortality rates were 0% (n = 0), 25% (n = 2) and 25% (n = 2) for the NTR group, and 63% (n = 5), 88% (n = 7), 100% (n = 8) for the TR group. After a mean period of 13 months, five (31%) patients were still alive, and one patient lost to follow-up after 11 months. The survivors (n=5) had all non-tumor-related ABF. Progression of underlying cancer and hemodynamic shock were the most common causes of death. Conclusions TEVAR represents a reliable option in the treatment of NTR ABFs. In the cases of TR fistulas and NTR AEFs, TEVAR should be applied more selectively. The associated mortality remains very high.