Thoracoscopic resection of residual aneurysm following hybrid aortic arch repair to prevent secondary aorto-oesophageal fistula in cases of severe oesophageal compression.

Secondary aorto-oesophageal fistulas after thoracic endovascular aortic repair are a severe complication associated with high mortality rates. We present a case of staged oesophageal decompression performed via thoracoscopic resection of a residual aneurysm following thoracic endovascular aortic repair to prevent secondary aorto-oesophageal fistulas in a patient with a distal arch aneurysm causing significant oesophageal compression. A 70-year-old woman with a 3-month history of hoarseness was referred to our hospital. Computed tomography revealed a penetrating ulcer in the aortic arch, complicated by a 60 mm pseudoaneurysm causing significant oesophageal compression. Owing to multiple comorbidities, the patient had high perioperative risk, rendering total arch replacement unfeasible; therefore, endovascular repair was selected. After Zone 1 hybrid thoracic endovascular aortic repair, complete thrombosis of the aneurysm was confirmed. Staged residual aneurysm resection was performed via thoracoscopy through a small left thoracotomy relieve oesophageal compression. Two years postoperatively, computed tomography revealed aneurysmal reduction, complete resolution of the oesophageal pressure drainage and no evidence of secondary aorto-oesophageal fistula or stent graft infection.