Aortoesophageal Fistula

Abstract

Aortoesophageal fistulas are rare but highly fatal lesions which may develop as a result of many underlying disease processes. The usual or more common etiologies of aortoesophageal fistula include malignancy (especially esophageal), thoracic aortic aneurysms, suture line erosions after repair of vascular lesions such as aneurysms or aortic coarctation, foreign body ingestion, and trauma. Symptoms may be insidious or present acutely with massive hematemesis. Urgent evaluation and initiation of therapy within a few hours after presentation should provide the best therapeutic opportunity for stabilization of the patient and control of the bleeding. Currently, transfemoral endovascular stent grafting will usually offer the best chance for survival and the prevention of fatal hemorrhage. With stabilization, additional elective treatment options and further definitive surgery, if necessary, may be planned.