OBJECTIVE: Secondary aortoesophageal fistula (AEF) after thoracic endovascular aortic repair (TEVAR) is a rare but life-threatening complication. Definitive treatment guidelines are lacking, and surgical management has traditionally relied on staged procedures. Reports of successful single-stage repair with long-term follow-up remain scarce. This case report aims to describe the workup, surgical strategy, and long-term outcomes of a single-stage multidisciplinary repair of secondary AEF after TEVAR.
METHODS: We report the case of a 75-year-old man who presented with recurrent infectious episodes 9 years after TEVAR. A secondary AEF was diagnosed in May 2022. After the failure of conservative treatment (ie, antibiotic therapy) over approximately 1 year, a multidisciplinary team recommended definitive surgery. In April 2023, a single-stage repair was performed, comprising complete resection of the infected stent graft, in situ replacement with an antibiotic-soaked prosthesis, primary esophageal repair, and interposition of a pedicled latissimus dorsi muscle flap.
RESULTS: The patient was discharged on postoperative day 30. Three-year follow-up demonstrated sustained remission with normalized inflammatory markers and no evidence of graft reinfection.
CONCLUSIONS: In this case report, a single-stage multidisciplinary surgical repair of secondary AEF after TEVAR yielded durable infection control and favorable long-term outcomes. Careful patient selection within a multidisciplinary team, meticulous surgical planning, and close postoperative infectious disease follow-up are essential. Three-year follow-up demonstrated sustained remission with normalized inflammatory markers and no evidence of graft reinfection.
}}, author = {{Zeyara, Adam and Al Saedi, Firas and Fransson, Torbjörn and Nozohoor, Shahab and Ahl, Jonas and Wierup, Per and Johansson, Jan}}, issn = {{2666-2507}}, language = {{eng}}, publisher = {{Elsevier}}, series = {{JTCVS Techniques}}, title = {{Single-stage multidisciplinary surgical repair of a secondary aortoesophageal fistula : A technical case report with 3-year uneventful follow-up}}, url = {{http://dx.doi.org/10.1016/j.xjtc.2026.102417}}, doi = {{10.1016/j.xjtc.2026.102417}}, volume = {{38}}, year = {{2026}}, }