Management of secondary aorto-oesophageal fistula after aortic arch replacement: a case report without aortic reconstruction.

Background: Secondary aorto-oesophageal fistula (AEF) after aortic aneurysm repair is a rare but clinically catastrophic complication. Conservative management is associated with an unacceptably high risk of mortality, primarily due to severe infections. Although definitive Case summary: A 74-year-old man was referred to our hospital with haematemesis, and a pseudoaneurysm was identified at the distal anastomosis site following total aortic arch replacement. Emergency thoracic endovascular aortic repair (TEVAR) was performed as a life-saving measure to achieve rapid haemostasis and stabilization. One month later, persistent fever and a residual oesophageal perforation prompted oesophagectomy with omental flap placement, without aortic arch reconstruction. Gastric conduit reconstruction was performed 4 months after TEVAR. The patient has remained event-free for more than 1 year after the initial presentation and intervention. Discussion: This case highlights the importance of an individualized treatment strategy for secondary AEF. In selected patients, infection control may be achieved without aortic arch reconstruction.