Prophylactic aortic stent prevents massive hemorrhage and hematemesis following definitive esophageal chemoradiation in a patient with pre-treatment aortic involvement.

As the third most common etiology of a uniformly fatal aortoesophageal fistula (AEF), locally advanced esophageal cancer with tumor involvement of the aorta poses a significant clinical dilemma. 1 Hollander J.E. Quick G. Aortoesophageal fistula: A comprehensive review of the literature. Am Journal Med. 1991; 91: 279-287 Abstract Full Text PDF PubMed Scopus (206) Google Scholar Our institution previously reported on a patient who experienced massive fatal hematemesis after developing an AEF after treatment with definitive chemoradiation for a locally advanced T4 esophageal cancer with thoracic aorta involvement. 2 McGinnis G.J. Holland J.M. Thomas Jr., C.R. Nabavizadeh N. Massive hemorrhage following definitive esophageal chemoradiation: Teaching case of a fatal aortoesophageal fistula and lessons learned. Clin Case Rep. 2017; 5: 2074-2079 Crossref PubMed Google Scholar Options for treatment after AEF formation are minimally effective; given the likelihood of rapid clinical demise exemplified by our previous patient's course, AEF prevention is a priority. 3 Akashi H. Kawamoto S. Saiki Y. et al. Therapeutic strategy for treating aortoesophageal fistulas. Gen Thorac Cardiovasc Surg. 2014; 62: 573-580 Crossref PubMed Scopus (42) Google Scholar , 4 Canaud L. Ozdemir B.A. Bee W.W. Bahia S. Holt P. Thompson M. Thoracic endovascular aortic repair in management of aortoesophageal fistulas. J Vasc Surg. 2014; 59: 248-254 Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar , 5 Ishikawa N. Maruta K. Oi M. Iizuka H. Kawaura H. Omoto T. Thoracic endovascular repair for aorto-esophageal fistula in patients with esophageal carcinoma: Report of 3 cases. Vasc Endovasc Surg. 2013; 47: 65-69 Crossref PubMed Scopus (11) Google Scholar