Aortoesophageal fistula as a complication of thoracic aorta stent graft implantation: two cases and literature review

Abstract

Thoracic endovascular aortic repair (TEVAR) is a method of choice in the treatment of thoracic aorta aneurysms and dissections. In case of a thoracoabdominal aneurysm, endovascular treatment is also being chosen more often, especially in patients with multimorbidity. Despite better results and less invasiveness in comparison to classic open surgery, endovascular treatment is also associated with complications. One of the rarer and usually fatal complications are aortoesophageal fistula (AEF). We present two cases, in which TEVAR complication was AEF. Case 1 was an 87-year-old woman with a history of TEVAR 5 years earlier, who presented increased inflammation parameters, massive gastrointestinal bleeding, and progressive anemia. Case 2 was a 66-year-old woman with a history of TEVAR 6 months earlier, who on admission presented medium increased inflammatory markers and anemia. None of the patients was qualified for surgical treatment. Both patient 1 and patient 2 died during hospitalization. Diagnostic imaging plays a key role in the diagnosis of AEF. CT angiography performed in patients with AEF can show the presence of gas in the sac of aneurysm as a result of infection, a defect in the aortic wall, or thickened esophagus with fluid level. CT angiography of the aorta combined with esophagogastroduodenoscopy (EGD) and contrast-enhanced X-ray examination of the gastrointestinal tract, enables to confirm or exclude the diagnosis of AEF. Atypical clinical feature and increased parameters of inflammation in patients with the history of TEVAR should always suggest the presence of AEF.