Case Report: Aortoesophageal Fistula induced by a fish bone: the critical role of mediastinal infection control after TEVAR and endoscopic closure

Background: Foreign-body-related aortoesophageal fistula (AEF) is rare and fatal without rapid hemostasis and infection control. Case: A 74-year-old woman presented with hematemesis and shock after suspected fish-bone ingestion. Emergency TEVAR with a 32 mm covered stent-graft (proximal landing in the distal third of the left subclavian artery) controlled bleeding. Endoscopic clip-and-line closure of an approximately 15 mm esophageal defect was performed. Despite broad-spectrum antimicrobial therapy, the patient developed recurrent fever and later rebleeding associated with mediastinal sepsis. Conclusion: TEVAR and endoscopic repair require an integrated, early source-control strategy. A stepwise algorithm prioritizing timely mediastinal drainage is essential to prevent graft contamination, infectious relapse, and rebleeding.