Endoluminal stenting of the aorta as treatment of aortoesophageal fistula due to primary aortic disease

A 78-year-old woman with severe chronic obstructive pulmonary disease was admitted to the emergency room with hematemesis. With use of esophagoscopy, chest computed tomographic scanning, and aortography, we found a large descending aortic aneurysm and a penetrating ulcer of the proximal descending aorta. We determined that the patient had an aortoesophageal fistula and pseudoaneurysm that had originated from a ruptured penetrating ulcer of the mid-descending aorta. We deployed two 100-mm stent grafts to seal the ruptured thoracic aorta. Six months later, the pseudoaneurysm was almost completely resolved, with no infection or endoleak. We advocate the use of endoluminal aortic stenting for aortoesophageal fistulas of aortic origin, particularly in patients with severe concomitant disease.