Secondary aorto-esophageal fistula after thoracic aortic aneurysm endovascular repair treated by covered esophageal stenting

Abstract

Thoracic endovascular aortic repair for thoracic aortic aneurysms is an accepted alternative to open surgery, especially in patients with significant comorbidities. The procedure itself has a low risk of complications and fistulas to surrounding organs are rarely reported. An 86-year-old patient was admitted to our hospital with gastro intestinal (GI) bleeding and a suspected aortoesophageal fistula. Eight months prior, the patient had undergone a stent graft repair of a mycotic thoracic aneurysm. Computerized tomography angiography and upper GI endoscopy confirmed an aortoesophageal fistula, which was treated by esophageal stenting. With early recognition, esophageal stenting may have a role in the initial emergency control of bleeding from and palliation of aortoesophageal fistula.

Keywords: Endovascular therapy; Bleeding; Aortic aneurysm

Core tip: Thoracic endovascular aortic repair (TEVAR) for thoracic aortic aneurysms is an accepted alternative to open surgery, especially in patients with significant comorbidities. The procedure itself has a low risk of complications and fistulas to surrounding organs are rarely reported. Aortoesophageal fistula post-TEVAR is a very rare entity; however, it is a devastating and usually fatal condition. Treatment options are very restricted, as these patients are often not candidates for complex surgery. We consider the placement of a covered self-expanding esophageal stent to be useful in the management of secondary aortoesophageal fistula after TEVAR to prevent re-bleeding in the fragile patient.