Conservative Treatment of Aortoesophageal Fistula after Thoracic Endovascular Aortic Repair

Background: We present the 1-year follow-up of a patient with secondary aortoesophageal fistula, after emergency endovascular treatment of a covered ruptured aortic ulcer of the thoracic aorta with successful endoscopic closure of the fistula by fibrin glue application.

Case: A 65-year-old patient underwent percutaneous TEVAR in zone 2 supplemented with implantation of carotid-subclavian bypass and plug implantation into the subclavian artery because of ruptured aortic ulcer. The postoperative course was unremarkable. Three weeks later, the control CT revealed mediastinitis with 2 mm aortoesophageal fistula. A multidisciplinary decision discussed open surgical repair including radical debridement of infected tissue and replacement of the aorta and esophagus. The patient denied the operation and preferred conservative therapy. After serial endoscopic vacuum treatment of the esophagus (four changes over 15 days) with enteral food restriction, the fistula could be closed endoscopically by application of 1 mL fibrin glue with a good outcome in 1-year follow-up control.

Discussion: The surgical management of aortoesophageal fistula, especially after previous TEVAR, is associated with high morbidity and mortality. An endoscopic vacuum therapy of the esophagus under oral antibiotic therapy may be feasible to treat aortoesophageal fistulae. Surgical backup remains a necessity.

Publication History

Article published online:
09 February 2023