Emergency Endovascular Treatment of An Aortoesophageal Fistula with Torrential Bleeding After Mediastinal Mass Resection

A 67 years old female patient was admitted to the emergency room with acute massive gastrointestinal hemorrhage. She had been operated for the resection of a mediastinal sarcoma 3 weeks before. A segment of the esophagus had been resected within the tumor and was reanastomosed in an end-to-end fashion. In light of the previous history, an aorto-esophageal fistula (AEF) was sus- pected. Emergent endoscopy revealed massive clots and active bleeding at the level of the esopha- geal anastomosis. CT also revealed contrast extravasation into the esophagus. The esophageal side of the defect was controlled by inflation of the esophageal balloon of a Sengstaken-Blakemore tube. Then the AEF was totally controlled by implantation of an aortic endovascular stent-graft. The pa- tient had no gastrointestinal hemorrhage until she died of pneumonia 30 days later. Aorto-esophageal fistula remains to be a highly lethal complication of thoracic surgery. Endovascular stent implantation within the aorta is a fast and effective technique to control the massive bleeding, but other risks such as life-threatening infections remain until definitive therapy may be achieved.