Background Aortoesophageal fistula (AEF) is a rare but life-threatening
condition. Secondary AEF is a complication of previous surgery, and can
be more critical and challenging than primary AEF. The number of cases
of secondary AEF is increasing due to increasing number of thoracic
endovascular aortic repair (TEVAR) performed. Although TEVAR has become
a successful alternative surgical strategy for thoracic aortic
aneurysms, secondary AEF after TEVAR may occur because of severe
adhesion between the esophagus and residual thoracic aortic wall.
Methods This study analyzed six patients with secondary AEF who were
treated at Tokyo Medical University Hospital between 2011 and 2016.
These participants included four patients who had undergone TEVAR and
two who had undergone total arch replacement. Results Open surgical
repair was completed in two patients who had undergone total arch
replacement. TEVAR alone was performed in two patients who had undergone
TEVAR. Combined repair of TEVAR as a bridge to open surgery was planned
for two patients who had undergone TEVAR. However, reconstruction of the
aorta and esophagus could not be completed in these patients due to
severe adhesions, and they died during hospitalization. Conclusions
Definitive open repair was successfully performed in patients with
secondary AEF after total arch replacement. However, in the patients
with secondary AEF after TEVAR, severe adhesion between the aorta and
esophagus led to difficulty in performing a successful definitive open
repair. The strategy for secondary AEF should, therefore, be decided
considering the etiology of secondary AEF.