Aortoesophageal Fistula: A Fatal Complication of Thoracic Endovascular Aortic Stent-Graft Placement.

BACKGROUND Hemetemesis is rarely caused by an aorta-esophageal fistula with thoracic aorta aneurysm in patients. This uncommon etiology, AEF/TAA, can potentially rupture and cause death if left untreated. Thoracic endovascular aorta repair places a stent-graft to seal the aneurysm and cover the fistulous track. Open surgical repair is associated with high risk of morbidity and mortality; therefore, TEVAR is a much safer alternative to it. However, recurrent or persistent infection remains a major concern with TEVAR for AEF. CASE REPORT We present a rare case of an 80-year-old woman who presented with complaints of hemetemesis and epigastric pain. The patient underwent a computerized tomography scan, highlighting a TAA and AEF. A stent was placed in the descending thoracic aorta via endovascular approach and a subsequent EGD was negative for any residual bleeding. Methicillin-resistant Staphylococcus aureus was isolated from the patient's sputum cultures and she was treated with a prolonged course of antibiotics. She presented to the hospital a few weeks later with new-onset hematemesis. Workup identified an AEF. The patient was high risk for open surgical repair due to her comorbid conditions; therefore, an esophageal stent was placed. She was diagnosed with AEF secondary to an infected endovascular thoracic aorta stent. CONCLUSIONS Patients who are high risk for open surgical repair from immediate rupture of TAA with AEF can benefit from use of the TEVAR approach. The stent itself is a foreign body; therefore, the risk of infection persists. AEF is a rare but potentially fatal complication of the infected thoracic aortic stent itself.