Aortoesophageal fistula: An endovascular emergency

Abstract

Introduction: The aortoesophageal fistula is a rare entity with a poor prognosis. The typical clinical presentation is as described by Chiari: dysphagia/chest pain, sentinel bleeding, and massive hemorrhage. Upper gastrointestinal endoscopy and computed tomography scan are fundamental for diagnosis. As for treatment, it is not clearly established. The aim of this article is to present our experience with a case of aortoesophageal fístula treated through transaxillary Thoracic Endovascular Aortic Repair (TEVAR). Methods: A 63-year-old male patient with a history of diabetes mellitus, smoker, chronic renal failure, and peripheral vascular disease presented with an episode of hematemesis with associated syncope and melaena. The patient underwent upper gastrointestinal endoscopy and computed tomography with intravenous contrast. After diagnosis, the patient underwent implantation of a Medtronic Valiant Navion stent graft via left transaxillary approach after placement of a Sengstaken-Blakemore catheter. Results: Endoscopy suggested an aortoesophageal fistula, and computed tomography revealed 2 aneurysms in the descending aorta, one of which was in contact with the esophagus. The patient underwent implantation of a stent graft via transaxillary approach after placement of a Sengstaken-Blakemore tube, with good clinical outcome. Conclusions: The aortoesophageal fistula is a rare and potentially lethal entity that requires a high diagnostic suspicion and emergency treatment, which is not established. Stent graft implantation is a safe therapeutic option as a bridge to patient stabilization, but definitive treatment must be individualized according to case characteristics and etiology.