An approach for treating aortoesophageal fistula Chen X et al. CLINICS 2011;67(2):195-197 Figure 1 - CT angiography images. A) Mediastinal esophageal fistula with inflammatory exudate surrounding the descending aorta (arrow). B) An aortic pseudoaneurysm at the anterior wall of the descending aorta at the lower edge of thoracic vertebrae 5 (arrow). NE returned to normal after 14 consecutive days of administration of the antibiotic meropenem based on cultures of the mediastinal exudates, which were positive for Pseudomonas aeruginosa seven days after the operation. The patient was switched to oral antibiotics and discharged on May 18, 2011. He was re-admitted to remove the esophageal stent 80 days after the operation. Esophageal endoscopy revealed a complete healing of the original fistula after removal of the esophageal stent (Figure 2B). No fever was observed during the treatment follow-up. After continuous administration of oral antibiotics for three months, the patient stopped the medication when blood laboratory findings and chest X-ray results were normal. The patient lived a normal life during six months of follow-up after the operation. DISCUSSION The widely accepted approach for treating AEFs caused by foreign bodies is a thoracotomy with aortic stent-graft interposition followed by reconstruction of the esophagus. However, this procedure has extremely high mortality and morbidity rates (4,5). The formidable challenges in treating these injuries are rupture of the AEF, mediastinal infection caused by esopha- geal perforation and endovascular stent-graft infection. Although several successful cases have been documented since the first AEF operation reported by Ctercteko (6) in 1980, the survival rate of patients with AEF has remained dismal. Zhang et al. (2) reported 32 cases of esophageal foreign body and/or aortoesophageal fistula between 1963 and 2010. Of 19 patients who underwent surgical interventions, three patients were completely cured and 16 patients died of fatal hemorrhage. The other 13 patients who were treated nonsurgically all died as a result of various treatments. The optimal management of AEFs remains controversial. With the rapid development of new endovascular techniques, endovascular aortic stent grafts have shown significant advantages over traditional open surgery for the treatment of aorta fistulas (1). Endovascular stent placement for AEF has been described with good results (3,7). Verhoeven et al. (1) suggested that endovascular aortic stent grafts should be considered as a first-choice lifesaving procedure. These grafts prevent fatal exsanguination and provide the valuable time necessary to optimize the patient’s condition before proceeding with additional treatments. Postoperative infections due to the placement of aortic stents depends on the treatment of the esophageal fistula, mediastinal drainage and anti-infection treatments. Esoph- ageal exclusion with mediastinal drainage followed by Figure 2 - Esophageal endoscopy. A) An esophageal fistula approximately 1.0 cm in diameter was found 25 cm away from the incisors prior to implantation of the esophageal stent (arrow). B) Complete healing of the original fistula after the removal of the esophageal stent (arrow). 196