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Secondary aortoesophageal fistula (AEF) is a catastrophic complication of endo− vascular graft placement [1]. The typical symptom of secondary AEF is massive gastrointestinal bleeding with a history of thoracic aortic aneurysm repair [2]. En− doscopy is the most sensitive and specific diagnostic study [3]. Endoscopy should be carefully performed, as it excludes other, more common causes of upper gas− trointestinal bleeding, but should be ter− minated if a fistula is identified. We pres− ent an endoscopic finding of secondary AEF. A 60−year−old woman was diagnosed with a mycotic thoracoabdominal aortic aneurysm and underwent resection of the aneurysm with an in−situ prosthetic interposition graft. Two weeks later, she developed massive hematemesis with hypotension. Emergency esophagoscopy revealed that the graft had eroded into the upper esophagus, with active bleed− ing (l " Fig. 1). Angiography with endo− vascular stenting and coil embolization were performed but failed to control the bleeding (l " Fig. 2). The patient died from exsanguinating hemorrhage.

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