Secondary aorto-esophageal fistula treated by covered esophageal stent and muscle wrapping.

Abstract Secondary aorto–esophageal fistula is rare, but associated with serious complications and high mortality. We devised a treatment strategy involving a covered esophageal stent, instead of esophageal resection, and placing the latissimus dorsi muscle around the infected aorta without removing the aorta and the stent graft. A 72-year-old man with a history of total arch replacement with a frozen elephant trunk for a thoracic dissecting aneurysm developed aorto–esophageal fistula and underwent surgical treatment using our strategy. He recovered well, and there is no evidence of re-infection 6 months after surgery. This strategy may be a less invasive surgical option.