CTICasesAortoesophageal Fistula Post-TEVAR Due to Stent Infection
Imaging findings
CT showed gas and wall thickening around an endovascular stent placed years prior for a penetrating atherosclerotic ulcer of the descending aorta. Oral contrast demonstrated a direct track encircling the stent and along the aorta, confirming communication between the esophagus and the periaortic space. The patient had a history of E. coli bacteremia.
Key takeaways
Aortoesophageal fistula is a severe complication following thoracic endovascular aortic repair (TEVAR), often driven by stent infection, especially in patients with bacteremia. Imaging with oral contrast can demonstrate direct communication between the esophagus and the periaortic space, or gas/wall thickening around the stent can be a clue. While a covered stent may initially prevent frank communication with the aortic lumen, the condition has high mortality if the graft fails.
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