World Journal of Surgery

, Volume 42, Issue 5, pp 1551–1558 | Cite as

Result of Thoracic Endovascular Aortic Repair for Patients with Esophageal Cancer

  • Akira Matsumoto
  • Yuji Kanaoka
  • Takeshi Baba
  • Reo Takizawa
  • Masayuki Hara
  • Koji Maeda
  • Katsunori Nishikawa
  • Yutaka Suzuki
  • Katsuhiko Yanaga
  • Takao Ohki
Original Scientific Report



Bleeding from the thoracic aorta is potentially fatal in patients with advanced esophageal cancer. Thoracic endovascular aortic repair (TEVAR) was recently applied for aortic invasion by esophageal cancer. However, only a few case reports have been published. This study was performed to clarify the effectiveness and safety of TEVAR for patients with advanced esophageal cancer.


We retrospectively reviewed 18 patients who underwent TEVAR for esophageal cancer. We also performed a literature search and reviewed 21 similar cases.


From 2007 to 2016, 10 patients were treated on an emergent basis for aortic hemorrhage (salvage group) and 8 patients underwent urgent prophylactic surgery (prophylactic group). Hemostasis was achieved in all cases. One (10%) patient in the salvage group died of aspiration pneumonia on postoperative day 1, while all patients in the prophylactic group survived for >1 month. The median survival period in the salvage and prophylactic group was 3.25 and 11.10 months, respectively. The longest survivor was still alive 9 years after TEVAR and chemoradiotherapy. No fatal adverse events or negative impacts on subsequent treatment for esophageal cancer occurred.


TEVAR is feasible, safe, and effective in preventing fatal aortic hemorrhage secondary to esophageal cancer invasion, although it is palliative in most cases. Because the outcomes of emergent TEVAR after bleeding tended to be worse in the salvage than in prophylactic group, prophylactic TEVAR may be considered a viable treatment option for patients with aortic invasion by advanced esophageal cancer.


Compliance with ethical standards

Conflict of interest

Dr. Takao Ohki is a paid consultant for W.L. Gore. The remaining authors declare that they have no competing interests.


  1. 1.
    Nemoto K, Takai Y, Ogawa Y et al (1998) Fatal hemorrhage in irradiated esophageal cancer patients. Acta Oncol 37:259–262CrossRefPubMedGoogle Scholar
  2. 2.
    Tachimori Y, Kanamori N, Uemura N et al (2009) Salvage esophagectomy after high-dose chemoradiotherapy for esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg 137:49–51CrossRefPubMedGoogle Scholar
  3. 3.
    Gowda RM, Misra D, Tranbaugh RF et al (2003) Endovascular stent grafting of descending thoracic aortic aneurysms. Chest 124:714–719CrossRefPubMedGoogle Scholar
  4. 4.
    Ohki T, Veith FJ (2000) Endovascular grafts and other image-guided catheter-based adjuncts to improve the treatment of ruptured aortoiliac aneurysms. Ann Surg 232:466–479CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Yamatsuji T, Naomoto Y, Shirakawa Y et al (2006) Intra-aortic stent graft in oesophageal carcinoma invading the aorta. Prophylaxis for fatal haemorrhage. Int J Clin Pract 60:1600–1603CrossRefPubMedGoogle Scholar
  6. 6.
    Matono S, Fujita H, Tanaka T et al (2011) Thoracic endovascular aortic repair for aortic complications after esophagectomy for cancer: report of three cases. Dis Esophagus Off J Int Soc Dis Esophagus/ISDE 24:E36–E40CrossRefGoogle Scholar
  7. 7.
    Kato N, Tadanori H, Tanaka K et al (2000) Aortoesophageal fistula-relief of massive hematemesis with an endovascular stent-graft. Eur J Radiol 34:63–66CrossRefPubMedGoogle Scholar
  8. 8.
    Okita R, Mukaida H, Takiyama W et al (2005) Successful surgical treatment of aortoesophageal fistula after esophagectomy. Ann Thorac Surg 79:1059–1061CrossRefPubMedGoogle Scholar
  9. 9.
    Cheema ZF, Davies MG, Walton BL et al (2011) Hybrid imaging to facilitate accurate placement of a thoracic endovascular aneurysm repair before completion esophagectomy. J Vasc Surg 54:1501CrossRefPubMedGoogle Scholar
  10. 10.
    Ishikawa N, Maruta K, Oi M et al (2013) Thoracic endovascular repair for aorto-esophageal fistula in patients with esophageal carcinoma: report of 3 cases. Vasc Endovasc Surg 47:65–69CrossRefGoogle Scholar
  11. 11.
    Dorweiler B, Weigang E, Duenschede F et al (2013) Strategies for endovascular aortic repair in aortobronchial and aortoesophageal fistulas. Thorac Cardiovasc Surg 61:575–580CrossRefPubMedGoogle Scholar
  12. 12.
    Okita Y, Yamanaka K, Okada K et al (2014) Strategies for the treatment of aorto-oesophageal fistula. Eur J Cardio Thorac Surg Off J Eur Assoc Cardio Thorac Surg 46:894–900CrossRefGoogle Scholar
  13. 13.
    Hollander JE, Quick G (1991) Aortoesophageal fistula: a comprehensive review of the literature. Am J Med 91:279–287CrossRefPubMedGoogle Scholar
  14. 14.
    Dake MD, Miller DC, Semba CP et al (1994) Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 331:1729–1734CrossRefPubMedGoogle Scholar
  15. 15.
    Slonim SM, Nyman UR, Semba CP et al (1996) True lumen obliteration in complicated aortic dissection: endovascular treatment. Radiology 201:161–166CrossRefPubMedGoogle Scholar
  16. 16.
    Makaroun MS, Dillavou ED, Wheatley GH et al (2008) Five-year results of endovascular treatment with the Gore TAG device compared with open repair of thoracic aortic aneurysms. J Vasc Surg 47:912–918CrossRefPubMedGoogle Scholar
  17. 17.
    Matsumura JS, Melissano G, Cambria RP et al (2014) Five-year results of thoracic endovascular aortic repair with the Zenith TX2. J Vasc Surg 60:1–10CrossRefPubMedGoogle Scholar
  18. 18.
    Hughes K, Guerrier J, Obirieze A et al (2014) Open versus endovascular repair of thoracic aortic aneurysms: a nationwide inpatient sample study. Vasc Endovasc Surg 48:383–387CrossRefGoogle Scholar
  19. 19.
    Kotelis D, Bischoff MS, Rengier F et al (2016) Endovascular repair of pseudoaneurysms after open surgery for aortic coarctation. Interact Cardiovasc Thorac Surg 22:26–31CrossRefPubMedGoogle Scholar
  20. 20.
    Faure EM, Canaud L, Agostini C et al (2014) Reintervention after thoracic endovascular aortic repair of complicated aortic dissection. J Vasc Surg 59:327–333CrossRefPubMedGoogle Scholar
  21. 21.
    Velazquez OC, Carpenter JP, Baum RA et al (1999) Perigraft air, fever, and leukocytosis after endovascular repair of abdominal aortic aneurysms. Am J Surg 178:185–189CrossRefPubMedGoogle Scholar
  22. 22.
    Schoder M, Cartes-Zumelzu F, Grabenwoger M et al (2003) Elective endovascular stent-graft repair of atherosclerotic thoracic aortic aneurysms: clinical results and midterm follow-up AJR. Am J Roentgenol 180:709–715CrossRefGoogle Scholar
  23. 23.
    Kanaoka Y, Ohki T, Maeda K et al (2016) Multivariate analysis of risk factors of cerebral infarction in 439 patients undergoing thoracic endovascular aneurysm repair. Medicine 95:e3335CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Bross PP, t Mannetje YW, Stokmans RA et al (2016) A 15-year single-center experience of endovascular repair for elective and ruptured abdominal aortic aneurysms. J Endovasc Ther Off J Int Soc Endovasc Spec 23:566–573Google Scholar
  25. 25.
    Biancari F, Mariscalco G, Mariani S et al (2016) Endovascular treatment of degenerative aneurysms involving only the descending thoracic aorta: systematic review and meta-analysis. J Endovasc Ther Off J Int Soc Endovasc Spec 23:387–392Google Scholar

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Akira Matsumoto
    • 1
  • Yuji Kanaoka
    • 1
  • Takeshi Baba
    • 1
  • Reo Takizawa
    • 1
  • Masayuki Hara
    • 1
  • Koji Maeda
    • 1
  • Katsunori Nishikawa
    • 1
  • Yutaka Suzuki
    • 2
  • Katsuhiko Yanaga
    • 1
  • Takao Ohki
    • 1
  1. 1.Department of SurgeryJikei University School of MedicineTokyoJapan
  2. 2.Department of SurgeryInternational University of Health and Welfare HospitalNasushiobara CityJapan

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