Management of an Aortoesophageal Fistula With Esophageal Endoluminal Wound Vacuum Therapy

A 39-year-old man with past medical history of type A aortic dissection presented to the emergency department with hematemesis, hypotension, and tachycardia. Imaging revealed an aortoesophageal fistula. The patient was taken emergently for thoracic endovascular aortic repair to cover the area of potential fistula. Due to the patient being a poor operative candidate, the decision was made to treat with endoluminal esophageal wound vacuum therapy. He underwent twice weekly endoscopies with sponge changes until discharge; he has done well since. Wound vacuum therapy in conjunction with thoracic endovascular aortic repair may represent a treatment option for patients with aortoesophageal fistula who are poor candidates for surgery.