Management of Aortoesophageal Fistula Primarily using Esophageal Preservation

Objective Aortoesophageal fistulas (AEF) are a rare, life-threatening condition. There is no consensus regarding the surgical management of the esophagus in this condition. Methods We retrospectively evaluated 13 patients diagnosed with AEF at a single institution from 2003-2021. Descriptive statistics were utilized to analyze patient characteristics, operative characteristics, and patient outcomes. Kaplan-Meier survival analysis was performed. Results Mean age was 63.5 years, and 6 (46.2%) were female. The most common presenting symptoms were hemoptysis/hematemesis (69.2%), chest/back pain (46.2%), and fever (38.5%). Twelve (92.3%) had history of aortic procedures. The median time between the index operation and repair of the secondary AEF in the 12 patients was 5 months. The index operation was a TEVAR in 10 of 12 patients (83.3%). Eleven (84.6%) patients underwent primary esophageal repair with flap coverage (omentum or muscle). One of these patients needed an esophagectomy within one year. The primary surgical management of the aorta was graft excision and replacement, aside from one patient who underwent primary repair. The 30-day survival was 69.2%, and 1-year and 5-year survival was 31.7%. There were no recurrent infections at the esophageal fistula site. Conclusions AEF remains a rare condition, but its case numbers have increased with TEVAR. It continues to be a difficult condition to manage and has a high fatality rate. Esophageal-preserving surgery may be a safe and less-invasive option for patients with a small defect.