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Aortoesophageal Fistula: Mending the Lethal Connection-A Systematic Review and Meta-Analysis.

Noor Abu Hantash·Hazem El Beyrouti·Yousef Alghzawi·Layan Lafi·Tariq Ziyad Al Dyrawi·Osama M Aldeeb·Omar M Nashwan·Raneem Munther Abuqtaish·Sara Fakeh·Patrick Bohan·Hassan Al Thani·Nancy Halloum
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Abstract

BACKGROUND: Aortoesophageal fistula (AEF) is a rare, life-threatening condition with limited high-quality evidence to guide management. METHODS: We conducted a systematic review and meta-analysis of PubMed and Scopus through December 2025, evaluating survival and complication outcomes according to treatment strategy and morphological severity. Patients were categorized into 5 groups: TEVAR alone, staged TEVAR followed by surgery, primary open or hybrid surgery, TEVAR with esophageal stenting, and supportive/palliative care. Outcomes were pooled as proportions with 95% confidence intervals (CIs). RESULTS: A total of 167 reports representing 528 patients were included. Overall 30-day mortality was 31.2% (95% CI 27.0% to 35.7%) and 1-year mortality 41.2% (95% CI 36.2% to 46.4%). Infection occurred in 32.6%, reintervention in 20.2%, and recurrence in 13.2%. Staged TEVAR followed by surgery showed favorable survival (30-day 12.7%, 1-year 26.1%) but high infection (66.7%) and reintervention (43.2%) rates. TEVAR with esophageal stenting had the lowest early mortality (5.0%) but frequent reintervention (54.5%) and 1-year mortality of 33.3%. TEVAR alone demonstrated the lowest 1-year mortality among definitive strategies (25.5%) but notable recurrence (26.9%). Primary open or hybrid surgery carried higher early and late mortality, while supportive/palliative care had the worst outcomes. Morphological severity correlated strongly with mortality, infection, reintervention, and recurrence, with type IV lesions showing particularly poor prognosis. CONCLUSION: Despite contemporary management, AEF carries high early and late mortality. Definitive strategies, particularly staged TEVAR followed by surgery, offer improved survival but increased complications. Morphology-guided, individualized management is recommended.

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AdultAgedAged, 80 and overFemaleHumansMaleMiddle AgedAortic DiseasesBlood Vessel Prosthesis ImplantationEndovascular ProceduresEsophageal FistulaPalliative CarePostoperative ComplicationsRisk AssessmentRisk FactorsStentsTime FactorsTreatment OutcomeVascular FistulaJournal ArticleSystematic ReviewMeta-AnalysisReview

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Noor Abu Hantash, Hazem El Beyrouti, Yousef Alghzawi, Layan Lafi, Tariq Ziyad Al Dyrawi, Osama M Aldeeb, Omar M Nashwan, Raneem Munther Abuqtaish, Sara Fakeh, Patrick Bohan, Hassan Al Thani, Nancy Halloum. 2026-06-25. Aortoesophageal Fistula: Mending the Lethal Connection-A Systematic Review and Meta-Analysis.. https://doi.org/10.1016/j.avsg.2026.06.013

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Adult subjectAged subjectAged, 80 and over subjectEndovascular Procedures subjectFemale subjectHumans subjectJournal Article subjectJournal Article; Systematic Review; Meta-Analysis; Review resourceMale subjectMeta-Analysis subjectMiddle Aged subjectPostoperative Complications subjectSystematic reviews study

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