A Case Suggestive of an Aorto-Esophageal Fistula Caused by Pseudoaneurysm at the Distal Anastomosis of an Aortic Graft: Long-Term Survival without Aortic Reconstruction

INTRODUCTION: Aorto-esophageal fistula (AEF) is a relatively rare and life-threatening condition. Although various treatment strategies have been developed, including conventional surgical repair, long-term survival remains uncommon. This report presents a case of AEF successfully treated without aortic reconstruction, resulting in long-term survival. CASE PRESENTATION: The patient was a 74-year-old male with a medical history of total arch replacement and severe emphysema, who presented to our department with hematemesis. Upper gastrointestinal endoscopy results revealed an AEF caused by the prosthetic graft. Emergency thoracic endovascular aortic repair was performed, followed by urgent subtotal esophagectomy the next day, without aortic reconstruction due to the patient's frailty. The patient underwent gastric conduit reconstruction via the presternal route 7 months later and has remained uneventful for over 6 years. CONCLUSIONS: The treatment without aortic reconstruction combined with conservative treatment for AEF might be feasible for high-risk surgical patients.