Novel Management of an Aortoesophageal Fistula Prior to Definitive Surgical Repair

Abstract

An aortoesophageal fistula (AEF) is a rare but often fatal complication associated with the placement of an aortic stent graft such as those utilized in thoracic endovascular aortic repair (TEVAR) procedures. Definitive surgical repair of AEF is the treatment of choice, as conservative management is nearly always fatal. We present the case of an AEF in a 74-year-old male managed by a unique treatment method; an esophageal stent was deployed to cover the fistula as a temporizing measure prior to definitive surgical correction, thus allowing time for resuscitation and hemodynamic optimization. The use of esophageal stents in the setting of AEF following TEVAR has been previously reported in the literature as a palliative measure for patients deemed incapable of tolerating open repair surgery. Our case demonstrates a new and innovative approach to the management of AEF following TEVAR in which the use of esophageal stenting is expanded beyond the role of palliative care and should be considered as a means to optimize at-risk patients prior to definitive corrective surgery in the hopes of improving outcomes.