# Aortic arch debranching and extra-anatomic bypass for the surgical treatment of aortoesophageal fistula secondary to thoracic endovascular aortic repair

## TL;DR

This study examines a surgical approach for treating a rare and dangerous condition called aortoesophageal fistula that occurs after a specific aortic repair procedure.

## Contribution

The study presents a surgical strategy combining aortic arch debranching and extra-anatomic bypass for post-TEVAR aortoesophageal fistula.

## Key findings

- The surgical approach showed no intraoperative mortality in 16 patients.
- Twelve patients had favorable recovery without prolonged antibiotic therapy.
- Four patients died postoperatively due to complications like aortic rupture and organ failure.

## Abstract

Aortoesophageal fistula (AEF) is a relatively rare and life-threatening condition, and the optimal surgical treatment for secondary AEF following thoracic endovascular aortic repair (post-TEVAR AEF) remains controversial. This study aimed to summarize the clinical efficacy of aortic arch debranching combined with extra-anatomic bypass for the treatment of post-TEVAR AEF.

The clinical data of 16 patients who underwent surgical treatment for post-TEVAR AEF at our institution from 30 June 2019 to 30 June 2024 were retrospectively reviewed. Aortic arch debranching and extra-anatomic aortic bypass under general anesthesia were performed for most patients. Empirical antibiotics were administered for 6–8 weeks. The acute and long-term outcomes were summarized.

Stent-related infection leading to AEF occurred at a median interval of 30 months after the initial TEVAR surgery. All patients presented with recurrent fever preoperatively; blood bacterial cultures were positive in nine patients (56.25%) and negative in seven patients (43.75%). The median operative time was 460.5 (433.5, 543.5) minutes, and the median intensive care unit stay was 7 (5.25, 31.75) days. No intraoperative mortality was observed in this cohort. During the follow-up period, three patients developed recurrent AEF accompanied by severe infection. Four patients died postoperatively, including one who died of thoracic aortic rupture and hemorrhage within 3 months postoperatively, and three others died of multiple organ failure at 4–10 weeks after surgery. The remaining 12 patients achieved favorable postoperative recovery without the need for prolonged antibiotic therapy.

Aortic arch debranching and extra-anatomic bypass from the ascending aorta to the proximal abdominal aorta yields favorable acute and long-term outcomes for patients with post-TEVAR AEF.