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Case Reports
. 2025 May 29;11(4):101837.
doi: 10.1016/j.jvscit.2025.101837. eCollection 2025 Aug.

Aortoesophageal fistula following thoracic branch endoprosthesis for cryptogenic penetrating aortic ulcer in a patient on pembrolizumab

Sarah Kim  1 , Patrick D Conroy  2 , Mark Zemela  2 , Bruce L Tjaden Jr  2
Affiliations
Case Reports

Aortoesophageal fistula following thoracic branch endoprosthesis for cryptogenic penetrating aortic ulcer in a patient on pembrolizumab

Sarah Kim et al. J Vasc Surg Cases Innov Tech. .

Abstract

Penetrating aortic ulcers are uncommon and life-threatening. We describe the case of a 67-year-old man who presented with fever and chills and was found on computed tomographic scan to have a thoracic penetrating aortic ulcer. The patient underwent placement of a thoracic branch endoprosthesis, with a postoperative course complicated by ileocolic pseudoaneurysm, progressive aortitis, and a fatal aortoesophageal fistula. The management of penetrating aortic ulcer in the setting of multiple confounding factors is discussed in the context of this patient's complex medical presentation, with a focus on the potential role of pembrolizumab in his disease progression.

Keywords: Aortoesophageal fistula; Pembrolizumab; Penetrating aortic ulcer; Thoracic branch endoprosthesis.

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Conflict of interest statement

None.

Figures

Fig 1
Fig 1
Index diagnostic computed tomography (CT) angiogram revealing posteromedial penetrating aortic ulcer (PAU) vs pseudoaneurysm. Three-dimensional reconstructions of the preoperative CT angiogram. (A) Posterior view (right anterior oblique [RAO], 100; cranial [CRA], 10). (B) Posterior view (RAO, 70; CRA 60). (C) Superior (left anterior oblique [LAO], 50; CRA, 70). (D) Axial CT angiography series.
Fig 2
Fig 2
Intraoperative angiography. (A) Predeployment thoracic aortogram. (B) Completion thoracic aortogram. (C) Postoperative computed tomography (CT) angiogram revealing exclusion of posteromedial aortic pathology.
Fig 3
Fig 3
Ileocolic artery pseudoaneurysm that presented on readmission. (A) Diagnostic computed tomography (CT) angiogram revealing contained pseudoaneurysm. (B) Angiogram and coiling in the interventional radiology suite. (C) Review of index diagnostic CT angiogram revealing mesenteric inflammation.
Fig 4
Fig 4
Final computed tomography (CT) scan revealing new anterolateral pseudoaneurysm with recurrent filling of original posteromedial aortic defect. (A) Three-dimentional reconstruction anterior view. (B) Axial CT angiography series.
See this image and copyright information in PMC

References

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