{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T01:40:08Z","timestamp":1773279608103,"version":"3.50.1"},"reference-count":24,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Aorto-esophageal fistula is a rare but life-threatening condition most often linked to thoracic aortic aneurysms and significant upper gastrointestinal bleeding. Thoracic endovascular aortic repair (TEVAR) is a crucial, life-saving procedure, but delayed complications, such as secondary esophageal fistulas caused by endograft erosion, can develop. Prompt recognition and multidisciplinary management are vital for survival. Case Presentation: We describe a 57-year-old patient with cardiovascular comorbidities and a saccular thoracic aortic aneurysm, who initially presented with massive hematemesis, melena, and hemodynamic instability. Imaging showed an aorto-esophageal fistula. Emergency treatment included placing a fully covered esophageal stent followed by TEVAR. Three weeks later, he experienced fever, chest pain, and worsening dysphagia. Laboratory tests indicated elevated inflammatory markers and hypoalbuminemia. Computed tomography revealed a new retrocardial esophageal fistula at T9, caused by mechanical erosion from the thoracic endograft. Endoluminal vacuum-assisted closure (EndoVAC) therapy was performed, leading to clinical improvement and the return of esophageal function. Conclusions: This case highlights a rare instance of a delayed secondary esophageal fistula after TEVAR beneath a preexisting stent, likely due to chronic contact between the endograft and esophagus. Despite advancements in endoscopic therapy, secondary fistulas after TEVAR are associated with high morbidity. Early diagnosis, aggressive infection management, structured nutritional support, and a multidisciplinary approach are essential. Extraluminal or intraluminal vacuum-assisted closure offers a promising minimally invasive option for managing complex esophageal defects.<\/jats:p>","DOI":"10.3390\/life16030460","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T10:43:27Z","timestamp":1773225807000},"page":"460","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["EndoVAC Therapy for Post-TEVAR Secondary Esophageal Fistula: A Rare Case of Delayed Secondary Esophageal Fistula After TEVAR Managed with Endoluminal Vacuum Therapy"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7911-0699","authenticated-orcid":false,"given":"Bogdan-Mihnea","family":"Ciuntu","sequence":"first","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreea","family":"Ludu\u0219anu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adelina","family":"Tanevscki","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rare\u0219 \u0218tefan","family":"Cost\u00e2rnache","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6083-7822","authenticated-orcid":false,"given":"Mihaela","family":"Corlade-Andrei","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Surgery II, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Ia\u0219i, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petru Radu","family":"Soroceanu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Vintil\u0103","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irina Mihaela","family":"Abdulan","sequence":"additional","affiliation":[{"name":"Department of Medical Specialties I, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9260-6322","authenticated-orcid":false,"given":"Mihai-Lucian","family":"Zabara","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"General Surgery Clinic, \u201cSt. Spiridon\u201d County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gheorghe","family":"Balan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Ia\u0219i, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.xjon.2024.04.004","article-title":"Management of aortoesophageal fistula primarily using esophageal preservation","volume":"16","author":"Mills","year":"2024","journal-title":"JTCVS Open"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.jvs.2013.07.117","article-title":"Thoracic endovascular aortic repair for aorto-esophageal fistula: A review of the literature","volume":"59","author":"Canaud","year":"2014","journal-title":"J. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.thorsurg.2024.07.004","article-title":"Aorto-esophageal Fistula Management","volume":"34","author":"Lagisetty","year":"2024","journal-title":"Thorac. Surg. 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