Staged open surgical repair of an aortic esophageal fistula in the setting of an aortic dissection

Aortoesophageal fistula is a rare but fatal complication commonly arising from thoracic aortic aneurysms or secondarily from thoracic endovascular aortic repair. Management remains challenging with few reports of durable repair. We present a 52-year-old woman with prior type A aortic dissection repair who developed persistent pain requiring arch replacement and thoracic endovascular aortic repair. She presented 4 months later with sepsis and imaging revealing extraluminal gas consistent with aortoesophageal fistula. She underwent graft explantation, debridement, and esophageal resection with delayed esophagostomy. Thirty months postoperatively, she remains stable. This case highlights early recognition and aggressive staged surgical management as critical for favorable outcomes.