title: Secondary aortoesophageal fistula after thoracic aortic aneurysm endovascular repair: literature review and new insights regarding the hypothesized mechanisms.
abstract: BACKGROUND
  Endovascular aortic repair was first performed nearly two decades ago and has become a well-established alternative therapy for many thoracoabdominal aortic diseases. Early survival results with the endovascular aortic repair were impressive, but it also brought many complications. Aortoesophageal fistula is little-known and may be underestimated because it is an unusual complication of thoracic endovascular aortic repair.
  
  
  OBJECTIVE
  To provide a review of the general features of aortoesophageal fistula as a little-known complication after thoracic endovascular aortic repair and to present a new insight regarding the hypothesized mechanisms of this complication based on clinical experience.
  
  
  METHODS
  The new insights regarding the hypothesized mechanisms built on the literature review and clinical experience. Literature Review from PubMed and Web of Knowledge for relevant studies with English paper. Searches were performed without year, and used the combinations of the following key words: "thoracic aortic aneurysm", "endovascular", "aortoesophageal fistula", "complication".
  
  
  RESULTS
  The authors' hypothesized mechanisms of aortoesophageal fistula after thoracic aortic aneurysm endovascular repair include the relatively thin vessel wall on thoracic aortic aneurysm hard to prevent the relatively rigid stent graft projecting the aortic and direct erosion into the esophagus.
  
  
  CONCLUSIONS
  Selecting flexibility and appropriate size stent graft, avoiding the thin aortic wall, and identifying the risk factors may reduce the morbidity of complications with aortoesophageal fistula after thoracic aortic aneurysm endovascular repair.
authors.affiliation: Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of Guangzhou Command Wuhan, 430070, Hubei Province, People's Republic of China.
authors.forename: Er-Ping
authors.initials: EP
authors.lastname: Xi
authors.affiliation: Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of Guangzhou Command Wuhan, 430070, Hubei Province, People's Republic of China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of Guangzhou Command Wuhan, 430070, Hubei Province, People's Republic of China.
authors.forename: Shui-Bo
authors.initials: SB
authors.lastname: Zhu
authors.affiliation: Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of Guangzhou Command Wuhan, 430070, Hubei Province, People's Republic of China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
keywords: Thoracic aortic aneurysm; aortoesophageal fistula; complication; endovascular; hypothesized mechanisms