Aorto-oesophageal fistula nine years after thoracic endovascular aortic repair: an autopsy-confirmed case report

Aorto-oesophageal fistula (AEF) is a rare but catastrophic complication following thoracic endovascular aortic repair (TEVAR).

An elderly man with a history of TEVAR for thoracic aortic aneurysm was admitted for acute decompensated heart failure. During hospitalization, he developed persistent fever. Computed tomography revealed air within the descending thoracic aortic aneurysm and loss of the fat plane between the aneurysm and the oesophagus, raising suspicion of AEF. Conservative management was selected because of his advanced age and comorbidities, and he died on hospital day 41. Autopsy confirmed a fistulous connection between the thoracic aorta and the oesophagus.

A deep oesophageal ulcer corresponding to aortic pulsation had been documented two months before admission, suggesting that chronic mechanical stress and ischaemic injury may have contributed to fistula formation. This case highlights that AEF can occur even many years after TEVAR and may initially present with non-specific symptoms.