ORIGINAL RESEARCH article
Front. Bioeng. Biotechnol.
Sec. Biomechanics
Aortic arch debranching and extra-anatomic bypass for the surgical treatment of aortoesophageal fistula secondary to thoracic endovascular aortic repair
Provisionally accepted
- Department of Cardiovascular Surgery, Shanghai Delta Health Hospital, Shanghai, China
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Background: Aortoesophageal fistula (AEF) is a relatively rare and life-threatening condition, and the optimal surgical treatment for secondary AEF following thoracic endovascular aortic repair (post-TEVAR AEF) remains controversial. This study aimed to summarize the clinical efficacy of aortic arch debranching combined with extra-anatomic bypass for the treatment of post-TEVAR AEF. Methods: The clinical data of 16 patients who underwent surgical treatment for post-TEVAR AEF at our institution from June 30, 2019 to June 30, 2024 were retrospectively reviewed. Aortic arch debranching and extra-anatomic aortic bypass under general anesthesia were performed for most patients. Empirical antibiotics were administered for 6-8 weeks. The acute and long-term outcomes were summarized. Results: Stent-related infection leading to AEF occurred at a median interval of 30 months after the initial TEVAR surgery. All patients presented with recurrent fever preoperatively; blood bacterial cultures were positive in 9 patients (56.25%) and negative in 7 patients (43.75%). The median operative time was 460.5 (433.5, 543.5) minutes, and the median Intensive Care Unit stay was 7 (5.25, 31.75) days. No intraoperative mortality was observed in this cohort. During the follow-up period, three patients developed recurrent AEF accompanied by serious infection. Four patients died postoperatively, including one died of thoracic aortic rupture and hemorrhage within three months postoperatively, and three died of multiple organ failure from four to ten weeks after surgery. The remaining 12 patients achieved favorable postoperative 3 recovery without the need for prolonged antibiotic therapy. Conclusion: Aortic arch debranching and extra-anatomic bypass from the ascending aorta to the proximal abdominal aorta yields favorable acute and long-term outcomes for post-TEVAR AEF patients.
Keywords: antibiotic treatment, Aortoesophageal fistula, Clinical data, surgical treatment, Thoracic endovascular aortic repair
Received: 11 Jul 2025; Accepted: 21 Jan 2026.
Copyright: © 2026 Lang, Sun, Liu, Jian, Peng, Lin and Xia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yu Xia
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