Aorto-oesophageal fistula following TEVAR: an unusual cause of mediastinal air.

Aorto-oesophogeal fistula (AEF) following thoracic endovascular aneurysm repair (TEVAR) has an incidence of 1.7%. Patients often present with constitutional symptoms or haematemesis and the condition is frequently fatal. We present a 79-year-old man who underwent TEVAR to exclude a ruptured 5.3 cm aneurysm. He re-presented with persistent fever and haematemesis and initially underwent oesophogastroduodenoscopy and biopsy to exclude oesophageal carcinoma. Following CT scanning AEF was diagnosed and extra-anatomical reconstruction was performed. Two months later he suffered a sudden and unexpected large bleed into his ventilator circuits from his tracheostomy and died. Haematemesis following TEVAR should raise clinical suspicion of AEF. Early and accurate diagnosis is paramount in view of the high attendant mortality. CT should be considered the initial investigation of choice.