A Case of Aortoesophageal Fistula Treated with Three-staged Esophageal Reconstruction after Thoracic Endovascular Aortic Repair

Abstract

A 57-year-old woman with a medical history of undergoing Stanford type B acute aortic dissection 11 months before presented with hematemesis. A computed tomography (CT) scan revealed an aortic arch aneurysm, and she was diagnosed with aortoesophageal fistula (AEF). Then, thoracic endovascular aortic repair (TEVAR) was emergently performed, and it was successful in gaining stable hemodynamics. After the infection subsided, we performed three-staged esophageal reconstruction for a radical cure. She became able to eat, and she was discharged home from our hospital. In addition to bleeding due to fistula between the aorta and the esophagus, infection of the aortic wall is the main symptom of AEF. Esophagectomy, removal of infected arterial tissue, and revascularization with artificial blood vessel are necessary as radical treatments. There are reports describing that the post-operative mortality rate is 3.1% and the in-hospital mortality rate is 18.8%. AEF is still a disease with a not-so-high lifesaving rate. We report a case of AEF treated with three-staged esophageal reconstruction to reduce surgical invasion after TEVAR along with some literature reviews.