Carotid-Esophageal Fistula Treated By Endovascular Approach

The carotid-esophageal fistula is a rare and serious complication of the metallic esophageal prosthesis. A high index of suspicion is required for early diagnosis and treatment, decreasing the morbidity and mortality rate of this severe complication. We report a case of a 4-year-old boy presenting severe upper gastrointestinal bleeding due to a carotid-esophageal fistula, secondary to deployment of an esophageal metallic prosthesis for treatment of a recurrent stenosis. The carotid pseudo-aneurism was successfully treated with stents and coils. Although endovascular treatment is a safe and effective option, arterial stenting in children needs further studies with long-term follow-up.

Oesophageal perforation – therapeutic and diagnostics challenge. Retrospective, single-center case report analysis (2009–2015)

Background: Esophageal perforation is a life-threatening condition of a complex etiology. No clear guidelines are available regarding the management of this condition. In this study, we review publications related to esophageal perforation, and analyze patients treated for this condition at our Department of Thoracic, General and Oncological Surgery. Objective: The objective of the study was to retrospectively assess and analyze management methods for esophageal perforations of different etiologies. All patients were treated in the Department of Thoracic, General and Oncological Surgery in years 2009-2015. Patients with perforations resulting from post-operational leaks within surgical anastomoses were excluded from the study. Material, methods, results: The analysis involved a total of 16 cases of esophageal ruptures. All cases were treated in years 2009-2015. Patients with perforations resulting from postoperative leaks within surgical anastomoses following elective surgeries for either oncological or non-oncological causes were excluded. The most common reason for esophageal rupture was iatrogenic injury (7 cases, 44%). Other causes included Boerhaave syndrome (5 cases, 31.2%), blunt trauma (2 cases, 12.5%), abscess perforation (1 case, 6.2%), and ulcer perforation (1 case, 6.2%). Ten patients underwent surgery, and the rest underwent esophageal prosthesis placement, of whom 2 cases required drainage of the mediastinum and pleural cavity. The mortality rate in the study group was 9/16 cases (56.2%). Conclusions: Esophageal perforation poses a significant interdisciplinary challenge regarding diagnostic workup, selection of treatment methods, and management of potential postoperative complications. This retrospective study was conducted in a single center. Although the analyzed period was long, we found only 16 cases. In spite of a variety of etiologies present, we found several statistically significant results of potential clinical value. 1. Most perforations that are not diagnosed within 48 hours affected the lower part of the esophagus and presented with unclear symptoms and imaging findings 2. Delaying diagnosis and treatment beyond 24 hours was associated with a higher mortality rate.

Optimizing the mechanical properties of a bi-layered knitted/nanofibrous esophageal prosthesis using artificial intelligence

The esophagus is a tubular multi-layer organ that carries the food bolus and liquids from the mouth to the stomach. Esophageal prostheses and scaffolds should have the appropriate mechanical and strain properties in the longitudinal and circumferential directions. A novel bi-layered esophageal prosthesis was produced using knitted tubular silk fabric and a coating of polyurethane (PU) nanofibers. The optimization process was performed in two steps. First, 12 different tubular structures of knitted silk fabrics were produced and mechanical properties were measured in both directions. The mechanical properties were optimized using an artificial neural network (ANN) and a genetic algorithm (GA) and the optimum knitted structure was produced as a substrate for coating with PU nanofibers. In second step, 20 different samples were produced by electrospinning the PU nanofibers at different process conditions (collector speed, feeding rate) on the optimized structure of the knitted fabric. Finally, the elastic properties of the bi-layered tubular structures were measured and optimized by the ANN and GA methods. Results presented show that the optimized structure of the esophageal prosthesis had proper mechanical properties similar to the esophagus. Such a structure can be used as a substitute in esophageal disorders.