Secondary Aortoesophageal Fistula Due to Thoracic Aortic Stent Graft: Is There a Role for Endoscopic Intervention?

Abstract

e present a case report of a 78-year-old man that was dmitted in our Intensive Care Unit after an urgent surgical epair of a stent-grafting endoleak and an aortobronchial stula. Five years before this event, he had been submitted o a thoracic endovascular repair of a descending thoracic orta aneurysm. The immediate post-operative course was uneventful. our days after surgery, the patient developed acute renal ailure, elevated inflammatory markers, bacteremia and efractory shock, although he was under therapy with broadpectrum antibiotics and there was no evidence of bleeding. CT-scan revealed a thickened esophageal wall and small as bubbles near the aortic stent graft suggesting an aortoeophageal fistula (Fig. 1). He was referred to our department or upper endoscopy and a fistula on the posterior surface of he middle third of the esophagus was recognized, through hich the aortic stent was observed (Fig. 2). With the diagosis of an aortoesophageal fistula secondary to the previous horacic endovascular repair technique, esophageal stening with a covered self-expanding esophageal stent with ltraflex Esophageal NG 23 × 100 mm (Boston Scientific®, nited States) was performed to help local infection control