Single-Stage Surgical Approach to Aortoesophageal Fistula After Thoracic Endovascular Aortic Repair

Abstract

Background: The aortoesophageal fistula (AEF) caused by thoracic endovascular aortic repair is a challenging condition. Traditional treatment approaches have been associated with high mortality and morbidity. This study introduces a modified single-stage surgical strategy that aims to optimize outcomes and to reduce the risk of recurrence for AEF. Methods: Our method involving mediastinal infection clearance, direct esophageal repair, aortic remnant cavity isolation with omental refilling, and aortic reconstruction with a Dacron graft (alongside the native aorta) was applied to all the patients. Results: None of the patients experienced intraoperative or in-hospital mortality. All 3 patients recovered well and exhibited successful repair and functionality at discharge. Our approach effectively controlled infection, repaired aortic and esophageal defects, and prevented future complications. Our experiences indicate a positive impact of this management strategy. Conclusions: Our single-stage surgical approach offers a promising solution for AEF after thoracic endovascular aortic repair, enhancing patients' quality of life. It achieves excellent outcomes in infection control and aortic and esophageal repair while avoiding the need for multiple staged surgical procedures.