Aortoesophageal fistulae following TEVAR: Case report and literature review

INTRODUCTION: Aortoesophageal fistulae are an uncommon pathology, primarily due to the aortic pathology in more than 50 % of the cases, followed by foreign body ingestion, and advanced malignancies. Recently it is recognized after surgical management of thoracic aortic pathologies either open or endovascular, with increased rates of morbidity and mortality. PRESENTATION OF THE CASE: We present a 62-year-old male patient with a previous history of thoracic endovascular aortic repair, who enters the emergency room with gastrointestinal bleeding and clinical signs of infection. Positive blood cultures, and tomographic signs include prosthetic gas, with endoscopic findings of aortoesophageal fistulae. Aggressive surgical management was performed including esophageal resection and gastrointestinal exclusion. Bleeding control was reached in the early postoperative period, nevertheless despite multidisciplinary management, the patient died 8 days after surgery. CLINICAL DISCUSSION: Aortoesophageal fistulae, remains to be an uncommon complication either of thoracic aortic aneurysm or after endovascular treatment of aortic aneurysm; with high rates of morbidity and mortality, should be suspected in every case with upper gastrointestinal bleeding in the context of a patient with aortic disease. Non-surgical management should be avoided due to the high risk of complications and mortality, aggressive management needs to be considered in each case according to clinical condition of the patient. CONCLUSION: Aortoesophageal fistulae remain an uncommon complication after TEVAR, with increased mortality and morbidity rates after complete treatment. Conservative management should be avoided to achieve bleeding control and prevent the extension of the infection.