# Two-Step Operation for Aortoesophageal Fistula After Thoracic Endovascular Repair

## TL;DR

A two-step surgical approach successfully treated a rare but serious complication after aortic repair in a 70-year-old man.

## Contribution

A novel staged surgical method using different approaches for treating aortoesophageal fistula after TEVAR is presented.

## Key findings

- The first step involved esophageal resection under a right thoracoscopic approach.
- The second step was descending aorta replacement via a left thoracotomy approach.
- The patient remained healthy for two years post-surgery without graft infection.

## Abstract

Aortoesophageal fistula (AEF) caused after thoracic endovascular aortic repair (TEVAR) is rare but a serious complication. We report a successful staged operation for AEF after TEVAR. A 70-year-old male underwent TEVAR for a ruptured aneurysm of the descending aorta and subsequently developed AEF three months later. First, the patient underwent the resection of the esophagus, which was the focus of the infection under the right thoracoscopic approach. Second, descending aorta replacement was performed using a left thoracotomy approach. The patient has been well for about two years since the second operation without recurring graft infection. Staged operation with a different approach to the infection zone is a useful method for AEF.