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Aorto-esophageal fistula (AEF) is a rare serious surgical event. The first case developed hematemesis 2 weeks post-sleeve gastrectomy. A covered esophageal stent was placed endoscopically. The esophageal stent implantation was followed by massive bleeding due to an AEF. A thoracic endovascular aortic repair (TEVAR) was performed. Aggravated by infection of the aortic stent, another massive bleed occurred after 1 year. The final procedure was resection of the descending aorta with reconstruction using a bovine pericardial patch. The second case presented with hematemesis post-motor vehicle accident. AEF was confirmed by aortogram and treated by TEVAR followed by fully covered esophageal stent. The patient declined definite surgery. In conclusion, initial endovascular approach is useful as a bridge procedure. Once the patient hemodynamics are stabilized, a definitive surgical repair is required. The post-repair infection and life-long antibiotics could be overcome by using bovine pericardial grafts.

Arterial dissection is defined as a tear in the inner lining of arteries, leading to the passage of blood between the layers and resulting in a false lumen. Arterial dissection involving the aorta is commonly seen in clinical practice; however, dissections involving the celiac and superior mesenteric arteries are quite rare. Even rare are isolated multiple visceral arterial dissections. A 59-year-old male with uncontrolled hypertension presented with epigastric pain. CT angiography revealed isolated dissection of the celiac and superior mesenteric arteries with ascending aortic ectasia, with no features of ischemia or organ dysfunction. He was managed conservatively with analgesics & anticoagulation. Repeat CT angiography after six months of anticoagulation therapy showed no progression of the disease. Isolated multiple visceral arterial dissection is a rare vascular disease that requires a high index of suspicion to diagnose. CT angiography is a useful imaging modality that helps not only in diagnosis but also in choosing a treatment plan. Though treatment options are controversial, conservative treatment with anticoagulation should be considered in uncomplicated cases of visceral arterial dissections.

Takayasu's arteritis is a rare inflammatory arteriopathy that affects predominantly young females and segmentally involves the aorta and its major branches. Infectious, hereditary, and autoimmune causes of Takayasu's arteritis have all been suggested; yet there is no consensus regarding its cause.