Case Report
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World J Gastrointest Surg. Jun 27, 2014; 6(6): 117-121
Published online Jun 27, 2014. doi: 10.4240/wjgs.v6.i6.117
Repair of an aberrant subclavian arterioesophageal fistula following esophageal stent placement
Maen Aboul Hosn, Fady Haddad, Fadi El-Merhi, Bassem Safadi, Ali Hallal
Maen Aboul Hosn, Bassem Safadi, Ali Hallal, Division of General Surgery, Department of Surgery, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon
Fady Haddad, Division of Vascular Surgery, Department of Surgery, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon
Fadi El-Merhi, Department of Diagnostic Radiology, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon
Author contributions: All authors actively participated in the design, drafting, revision and final approval of the manuscript prior to submission; Hosn MA and Safadi B did most of the literature review; Haddad F and El-Merhi F were involved in writing the manuscript and evaluating the relevance of the sources obtained; Hallal A did the manuscript editing and critical appraisal.
Correspondence to: Maen Aboul Hosn, Chief Resident, Division of General Surgery, Department of Surgery, American University of Beirut, P.O.Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon. ma198@aub.edu.lb
Telephone: +961-3-079863 Fax: +961-1-363291
Received: January 23, 2014
Revised: April 2, 2014
Accepted: May 29, 2014
Published online: June 27, 2014
Processing time: 178 Days and 16.7 Hours
Abstract

A fistula formation between the esophagus and an aberrant right subclavian artery is a rare but fatal complication that has been mostly described in the setting of prolonged nasogastric intubation and foreign body erosion. We report a case of a young morbidly obese patient who underwent sleeve gastrectomy that was complicated by a postoperative leak at the level of the gastroesophageal junction. A covered esophageal stent was placed endoscopically to treat the leak. The patient developed massive upper gastrointestinal bleeding secondary to the erosion of the stent into an aberrant retroesophageal right subclavian artery twelve days after stent placement. She was ultimately treated by endovascular stenting of the aberrant right subclavian artery followed by thoracotomy and esophageal repair over a T-tube. This case report highlights the multidisciplinary approach needed to diagnose and manage such a devastating complication. It also emphasizes the need for imaging studies prior to stent deployment to delineate the vascular anatomy and rule out the possibility of such an anomaly in view of the growing popularity of esophageal stents, especially in the setting of a leak.

Keywords: Aberrant subclavian artery; Arterioesophageal fistula; Esophageal stent; Esophageal repair; Angioplasty; Sleeve gastrectomy; Leak

Core tip: The use of esophageal covered stents to treat leaks following sleeve gastrectomy has increased significantly over the past years. However, their possible complications have not yet been fully explored. As demonstrated by our case report, the presence of an aberrant retroesophageal Subclavian artery can predispose to the formation of a fistula with the esophagus secondary to stent erosion, thereby leading to catastrophic hemorrhage and death. Our approach in this case was to start with stent angioplasty of the Subclavian artery followed by thoracotomy and esophageal repair over a T-tube and this approach proved successful in saving the patient’s life.