7 March 07,2006 TEVAR contained rupture Recent symptoms; Intense backpain & discomfort,no hematemesis, had been treatedfor unknown source of infectionlast 3-4monthsDiagnosis;contained ruptureChoice of treatment;TEVAR
12 AEF: a catastrophic complication Outcomes of thoracic endovascular aortic repair for aortobronchial and aortoesophageal fistulas.Jonker et all. J Endovasc Ther Aug;16(4):428-40CONCLUSION: TEVAR management of AEF is associated with poor results and should not be considered definitive treatment. TEVAR could serve as a bridge to surgery for emergency cases of AEF only, with definitive open surgical correction of the fistula undertaken as soon as possible..
13 AEF: a catastrophic complication Aortoesophageal fistula after thoracic aortic stent-graft placement: a rare but catastrophic complication of a novel emerging technique;Eggebrecht H et all, JACC Cardiovasc Interv Jun;2(6):570-6Surgical 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). CONCLUSION: AEF is a rare and unusual complication of TEVAR that occurs relatively early after the procedure and is almost invariably fatal..
14 New option to treat AEF Medical !! TEVAR !! Surgery!! Percutaneous drainage of infected aneurysm sac
15 CT guidance percutaneous drainage of infected aneurysm sac prone positiongeneral anesthesialeft endobronchial intubation to stop ventilation and collapse of the right lung to insert drainage catheter without damaging right lung.
16 Procedure: Two step technique 19 G TLA Needle to confirm the infected material,(Staphylococcus auricularis,Streptoccus viridans, Candida albicans),soft outer sheat stayed at position till the end of procedure (not to contaminate mediastinum & pleura)Insertion of the 10F pig-tail external drainage catheter from another level
20 Drainage catheter was removed after 2 weeks while CT-scan showed total regression of collection in aneurysm sac with improvement in patient’s clinical condition
21 Follow-up June 18 th ,2006 Control CT with oral contrast & eosphagraphy
22 Follow-up July 03 rd,2006 eosphagraphy & non contrast CT
23 Follow-upThe patient was under antibiotic therapy(Duocid,Tavanic,Triflucan) for a yearMI was the cause of death at 2008 ,2 years after percutaneous drainage
24 ConclusionPercutaneous drainage of infected anuersym sac can be a life saving option of patients having rare and unusual complication of AEF after TEVAR at suitable conditions.
25 AORTO-BRONŞİYAL FİSTÜL 1996 da torkal aort cerrahi girişimi2004 te hemoptiziCTDSA?TEVAR10 senelik takip altında, progresiv aterosklerotik anevrizma nedeni ile TEVAR disalde ÇT seviyesine kadar uzatıldı,AAA çap nedeni ile takipte.