Esophagobronchial Fistula Associated With Thoracoabdominal Aortic Aneurysmal Disease and Type IA Endoleak: When Dysphagia Precedes Respiratory Failure

Esophagobronchial fistula is a rare but life-threatening complication occurring in the setting of thoracoabdominal aneurysmal disease and previous thoracic endovascular aortic repair (TEVAR). We report the case of a 68-year-old man with chronic kidney disease, rheumatoid arthritis, and previous fenestrated/branched endovascular aortic repair (f/bEVAR) for a thoracoabdominal aortic aneurysm (TAAA) who presented with progressive dysphagia, postprandial vomiting, food intolerance, lumbar pain, and worsening dyspnea. Computed tomography (CT) angiography demonstrated extensive thoracoabdominal aneurysmal disease with a persistent type IA endoleak causing marked esophageal compression and the near-complete obliteration of the left main bronchus. Upper gastrointestinal endoscopy confirmed severe non-traversable extrinsic esophageal compression. Following multidisciplinary discussion, the patient underwent proximal TEVAR to exclude the persistent type IA endoleak. During the postoperative course, he remained ventilator-dependent and developed persistent bronchial secretions, recurrent pulmonary infections, and repeated unsuccessful weaning attempts, prompting further investigation. Repeat computed tomography demonstrated a fistulous communication between the esophagus and the left main bronchus. The diagnosis of esophagobronchial fistula was subsequently confirmed by flexible bronchoscopy and upper gastrointestinal endoscopy. This case highlights the importance of recognizing progressive dysphagia as an early manifestation of aneurysmal compression and maintaining a high index of suspicion for aerodigestive fistulization in patients with thoracoabdominal aneurysmal disease who develop persistent bronchial secretions, recurrent pulmonary infections, and repeated unsuccessful weaning from mechanical ventilation.