Aorta-esophageal fistula is an abnormal communication between the aorta and esophagus leading to life-threatening exsanguination via the GI tract. This can be caused by procedures (e.g., weeks following cardiac arrhythmia ablation), malignancy, foreign body, aortic aneurysm, etc.
Patients typically present with massive bright red GI bleeding that can be intermittent or persistent. Securing the airway can be extremely difficult due to ongoing hemorrhage, and unstable patients require immediate surgical intervention. If patients are more stable, additional workup (endoscopy, CT angiography, etc.) can be performed.
Thoracic endovascular aortic repair (TEVAR) can exclude the fistula and achieve source control of the bleeding from the aorta. In these video clips, you can appreciate the area of arterial extravasation (“blush”) before the TEVAR. This is no longer apparent following the TEVAR.
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