Secondary aortoesophageal fistula.

Secondary aortoesophageal fistula is the rarest type of aortopeptic fistula, characterized by communication between the reconstructed aorta and the esophagus. This condition has been reported to be uniformly fatal, even after prompt diagnosis and treatment. We report what may be the first case of a successfully managed secondary aortoesophageal fistula that occurred 14 months after repair of a Crawford type II thoracoabdominal aortic aneurysm. The entity was diagnosed with a combination of esophagogastroduodenoscopy and aortography. At exploration, a communication between the proximal anastomosis and the esophagus with otherwise minimal mediastinal contamination was encountered. The anastomosis was replaced with an interposition polytetrafluoroethylene graft, and the esophageal defect was debrided, primarily closed, and reinforced with adjacent old aneurysm wall. There were no postoperative complications, and the patient remains well 18 months after fistula repair.