Greetings, I am David junior doctor from Georgia.

I will be concise

Patient came to us with Chiari's Triad, an aortic-esophageal fistula was diagnosed. In esophagus and aorta stent grafts were inserted, after this procedure extravasation of contrast can not be seen in the aneurysm sac. However, the patient has episodes of severe pain and after vomiting the blood mass symptoms decrease in severity. After ct scan with contrast The aneurysm sac has no active blood supply source. In the attached file you can see the laminar flow in the exact location of aorta where the fistula was before inserting the stent. After conference, held in our hospital, it is assumed that we are dealing with some venous involvement, which causes a sluggish increase in pain. The patient is still held in ICU and waiting for our next decision. If you had a similar case, what was the next tactic? I would love to hear your advice from your experience to help the patient