Thoracic Endovascular Repair and Esophageal Stenting in Primary Aortoesophageal Fistula: A Case Report and Literature Review

Primary aortoesophageal fistula (AEF) is a catastrophic condition that often presents with hematemesis and retrosternal chest pain. A 72-year-old woman with multiple comorbidities, including long-standing hypertension, frailty with sarcopenia, low body mass index (BMI) (18.2 kg/m 2 ), and poor nutritional status, presented with massive hematemesis. Urgent endoscopy revealed an esophageal wall defect, and computed tomography angiography confirmed a primary AEF arising from a descending thoracic aortic aneurysm. Her predicted EuroSCORE II surgical mortality was >20%, and she was deemed unfit for open surgery. Emergency thoracic endovascular aortic repair was performed for hemorrhage control, followed 2 weeks later by endoscopic placement of a fully covered esophageal stent to isolate the fistula. Despite initial recovery with broad-spectrum antibiotics and supportive care, the patient succumbed to severe sepsis 1 month later. This case highlights the potential and limitations of a staged, minimally invasive hybrid approach in high-risk patients who are unfit for open surgery. AEF management requires individualized surgical decision-making, meticulous infection control, and structured follow-up to improve the outcomes.